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Encephalopathy complicating high-dose melphalan
A Schuh1, J Dandridge, P Haydon
1Department of Haematology, John Radcliffe Hospital, Oxford, UK.
Bone Marrow Transplantation
|December 1, 1999
Summary
High-dose melphalan (HDM) with stem cell transplant can cause severe encephalopathy in patients with renal failure. This rare neurological complication requires further investigation to understand its underlying mechanisms and improve patient outcomes.
Area of Science:
- Neurology
- Hematology
- Oncology
Background:
- High-dose melphalan (HDM) with peripheral blood stem cell transplant (PBSCT) is a standard therapy for multiple myeloma (MM) and AL amyloidosis (ALA).
- Renal failure is a known risk factor for adverse events in patients undergoing PBSCT.
Observation:
- Two female patients with severe renal failure developed severe encephalopathy with seizures and Glasgow Coma Scale (GCS) of 3/15 after HDM for MM and ALA.
- Infections, metabolic disturbances, cerebral ischemia, and hemorrhage were excluded as causes for encephalopathy.
Findings:
- One patient died while comatose 25 days post-transplant.
- The second patient recovered from encephalopathy 18 days after transplantation.
- This case series suggests a potential role for HDM in the development of encephalopathy in patients with renal impairment.
Implications:
- Highlights a potential neurotoxicity of HDM in patients with renal failure.
- Suggests the need for vigilant neurological monitoring in this patient population.
- Warrants further research into the mechanisms of HDM-induced encephalopathy and potential management strategies.