Melphalan-associated encephalopathy following autologous stem cell transplant: a transplanter's nightmare!
Suchita Shinde1, Vinay Anand Guntiboina1, Arijit Nag1
1Department of Clinical Haematology and Cellular Therapies, Tata Medical Center, Kolkata, India.
Abstract:
Melphalan-induced encephalopathy is a rare complication observed in patients undergoing autologous stem cell transplantation (ASCT) and is characterized by symptoms ranging from drowsiness to seizures. Previous reports have described similar cases, including a review of a large cohort of patients in whom melphalan-associated encephalopathy was identified in 2% of the patients undergoing ASCT. We describe the case of a 63-year-old male with Multiple Myeloma and underlying chronic kidney disease (CKD) who underwent ASCT with a reduced dose of melphalan due to renal dysfunction in complete remission following induction therapy and subsequent neurological deterioration, which necessitated an extensive evaluation of several neurological and infective etiologies. In this report, we highlight that melphalan-associated encephalopathy is a distinct entity complicating ASCT in patients with myeloma, especially in those with preexisting renal insufficiency, and consider its management.
Insights
Melphalan-induced encephalopathy is a rare complication after autologous stem cell transplantation (ASCT), particularly in myeloma patients with kidney issues. This case highlights the distinct neurological entity and its management considerations.
Area of Science:
- Neurology
- Hematology
- Nephrology
Background:
- Autologous stem cell transplantation (ASCT) is a treatment for multiple myeloma.
- Melphalan is a chemotherapy agent used in ASCT.
- Melphalan-induced encephalopathy (MIE) is a rare but serious complication of ASCT.
Observation:
- A 63-year-old male with multiple myeloma and chronic kidney disease (CKD) received a reduced dose of melphalan for ASCT.
- The patient experienced neurological deterioration post-ASCT, prompting an extensive diagnostic workup.
- Despite reduced dosage due to renal impairment, the patient developed symptoms consistent with MIE.
Findings:
- Melphalan-associated encephalopathy is a distinct clinical entity.
- Preexisting renal insufficiency is a significant risk factor for developing MIE after ASCT.
- The case underscores the importance of recognizing MIE in myeloma patients undergoing ASCT, even with dose modifications.
Implications:
- Early recognition and management of MIE are crucial for patient outcomes.
- This case emphasizes the need for careful monitoring of neurological function in ASCT patients with CKD.
- Further research into risk stratification and optimal management strategies for MIE in renal-compromised patients is warranted.
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