Hypercytokinemia-induced metabolic encephalopathy in a multiple myeloma patient on hemodialysis undergoing autologous stem cell transplantation: clinical response after plasma exchange.
We report here a 50-years old female with multiple myeloma-associated chronic renal failure who underwent high-dose chemotherapy supported by autologous hematopoietic stem cell transplantation. She developed progressive encephalopathy on day 5 progressing to coma despite hemodialysis and no obvious organ failure. She finally recovered after a single 1-liter plasma exchange. The final diagnosis was metabolic encephalopathy due to hypercytokinemia, particularly high serum TNF levels. We discuss here the pathogenesis and raise an alert for monitoring cytokine levels in patients with renal failure undergoing high-dose chemotherapy.
Focosi
Daniele
D
Division of Hematology, Department of Oncology, Transplants and Advances in Medicine, University of Pisa, Italy. dfocosi@tin.it
Pelosini
Matteo
M
Palla
Piero
P
Galimberti
Sara
S
Caracciolo
Francesco
F
Benedetti
Edoardo
E
Papineschi
Federico
F
Petrini
Mario
M
D001928:Brain Diseases, Metabolic / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003128:Coma; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009101:Multiple Myeloma / Q000503:physiopathology / Q000628:therapy*; D010951:Plasma Exchange; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000517:prevention & control; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects / Q000097:blood
D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan