A rare case of interstitial pneumonitis after tandem high-dose melphalan conditioning and autologous stem cell transplantation in multiple myeloma.
A 57-yr-old woman with multiple myeloma received an autologous tandem transplant at a 4-month interval. She was conditioned twice with 225 mg/m2 melphalan. After the second transplant, interstitial pneumonitis (IP) ensued. The clinical course was life threatening and mechanical ventilation was required for 32 d. All attempts to identify an infectious agent failed. A presumptive diagnosis of idiopathic IP, possibly related to melphalan toxicity, was made. High-dose methylprednisolone administration led to rapid and durable improvement. Melphalan was employed for conditioning in the tandem setting with an interval of only 3-4 months between two courses or a dose elevation to 225 instead of 200 mg/m2, may have induced IP which responded favorably to methylprednisolone.
Buxhofer-Ausch
Veronika
V
Second Department of Medicine, Danube Hospital, Vienna, Austria. veronika.buxhofer@wienkav.at
Ruckser
Reinhard
R
Kier
Peter
P
Habertheuer
Karl Heinz
KH
Zelenka
Peter
P
Tatzreiter
Georg
G
Ausch
Christoph
C
Schmid
Isabel
I
Hruby
Walter
W
Reiner-Concin
Angelika
A
Sebesta
Christian
C
Ogris
Emil
E
Hinterberger-Fischer
Margareta
M
Hinterberger
Wolfgang
W
D018943:Anthracyclines / Q000009:adverse effects; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000209:etiology; D008558:Melphalan / Q000009:adverse effects*; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000628:therapy*; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D018943:Anthracyclines; D008558:Melphalan; D008775:Methylprednisolone