Peripheral blood stem cell transplantation in a multiple myeloma patient with end-stage renal failure.
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.
Rebibou
J M
JM
Service de Néphrologie et Réanimation Métabolique, CHU Le Bocage, Dijon, France.
Caillot
D
D
Casasnovas
R O
RO
Tanter
Y
Y
Maillard
N
N
Solary
E
E
Rifle
G
G
Guy
H
H
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