[Acute plasma cell leukemia. Clinical course during high-dose melphalan therapy].
A 29-year-old woman, with a slightly elevated temperature for 3 weeks, increasing dyspnoea at rest, markedly reduced general condition and in heart failure, was found to have a leucocytosis of 100,000/microliters, anaemia (haemoglobin 6.3 g/dl) and thrombocytopenia (41,000/microliters). There were 62% plasma cells in the blood smear. Immunoelectrophoresis of serum and urine revealed kappa-light chains and immunocytology demonstrated IgG-kappa. There was no radiological evidence of osteolysis, while ultrasound examination showed multiple abdominal lymphomas and marked hepatosplenomegaly. Bone marrow smear showed a 90% infiltration of plasma cells. High-dosage melphalan treatment (single intravenous injection of 140 mg/m2) resulted in complete remission after myelodepression over several weeks. Two extramedullary recurrences 5 and 12 months after the diagnosis had been made were successfully treated with high-dosage melphalan, but it was associated with severe and long-lasting myelodepression. Septicaemia with renal and hepatic failure developed and the patient died 6 weeks after the third course of high-dosage melphalan, 14 months after the diagnosis.
Handt
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Medizinische Klinik II, Technischen Hochschule Aachen.
Handt
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Glöckner
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WM
D000208:Acute Disease; D000328:Adult; D001856:Bone Marrow Examination; D002452:Cell Count; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000302:isolation & purification; D007952:Leukemia, Plasma Cell / Q000175:diagnosis* / Q000188:drug therapy; D007970:Leukopenia / Q000139:chemically induced; D008558:Melphalan / Q000009:adverse effects / Q000627:therapeutic use*; D010950:Plasma Cells; D013921:Thrombocytopenia / Q000139:chemically induced
D007147:Immunoglobulin Light Chains; D008558:Melphalan
Akute Plasmazellenleukämie. Klinischer Verlauf unter hochdosierter Melphalantherapie.