Myopericarditis caused by cyclophosphamide used to mobilize peripheral blood stem cells in a myeloma patient with renal failure.
Cyclophosphamide (CPA) is widely used for peripheral blood stem cell mobilization, and a dose adjustment of CPA in the presence of renal failure has not been suggested. However, we describe a myeloma patient with renal failure (serum creatinine 4.2 mg/dl, creatinine clearance 11.2 ml/min) receiving CPA 2 g/m2 for 2 days, who developed unexpectedly severe toxicity, including myopericarditis and prolonged myelosuppression. The serial serum concentrations of CPA metabolites were persistently much higher than those in a myeloma patient with normal renal function. We consider, therefore, that the dose of CPA should be reduced in the presence of severe renal failure when used as high-dose therapy or to mobilize peripheral blood stem cells.
Yamamoto
R
R
Department of Hematology, National Cancer Center Hospital, Tokyo, Japan.
Kanda
Y
Y
Matsuyama
T
T
Oshima
K
K
Nannya
Y
Y
Suguro
M
M
Chizuka
A
A
Hamaki
T
T
Takezako
N
N
Miwa
A
A
Kami
M
M
Mori
S
S
Kojima
T
T
Saito
K
K
Itaoka
Y
Y
Kashida
M
M
D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects* / Q000097:blood / Q000493:pharmacokinetics; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000493:pharmacokinetics; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D009101:Multiple Myeloma / Q000097:blood / Q000378:metabolism / Q000628:therapy; D009205:Myocarditis / Q000139:chemically induced*; D010490:Pericardial Effusion / Q000139:chemically induced; D010493:Pericarditis / Q000139:chemically induced*; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications* / Q000378:metabolism
D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide