title: Peripheral blood stem cell transplantation in a multiple myeloma patient with end-stage renal failure.
abstract: Multiple myeloma with IgG kappa monoclonal gammopathy and oliguric renal failure requiring hemodialysis was diagnosed in a 49-year-old man. Conventional therapy with VAD (vincristin, adriamycin, dexamethasone) failed to induce a complete response (CR) but this was subsequently obtained following two cycles of high-dose intravenous melphalan (70 mg/m2). A relapse occurred 8 months after CR which was treated by intensive myeloablative therapy combining total body irradiation (6 Gy over 2 days) and high-dose intravenous melphalan (140 mg/m2) followed by supportive PBSC transplantation. Hemodialysis was performed every other day during the myeloablative therapy and subsequent aplasia. Fluid subtraction allowed 1500 Cal/day intravenous alimentation and the only adverse event observed was a severe mucositis. A second CR was obtained which lasted 14 months. This observation indicates that multiple myeloma patients with end-stage renal failure can receive intensive myeloablative therapy without major toxicity.
authors.affiliation: Service de Néphrologie et Réanimation Métabolique, CHU Le Bocage, Dijon, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Rebibou
authors.forename: D
authors.initials: D
authors.lastname: Caillot
authors.forename: R O
authors.initials: RO
authors.lastname: Casasnovas
authors.forename: Y
authors.initials: Y
authors.lastname: Tanter
authors.forename: N
authors.initials: N
authors.lastname: Maillard
authors.forename: E
authors.initials: E
authors.lastname: Solary
authors.forename: G
authors.initials: G
authors.lastname: Rifle
authors.forename: H
authors.initials: H
authors.lastname: Guy
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000473:pathology / Q000628:therapy*; D012008:Recurrence; D014182:Transplantation, Autologous