title: Hypercytokinemia-induced metabolic encephalopathy in a multiple myeloma patient on hemodialysis undergoing autologous stem cell transplantation: clinical response after plasma exchange.
abstract: 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.
authors.affiliation: Division of Hematology, Department of Oncology, Transplants and Advances in Medicine, University of Pisa, Italy. dfocosi@tin.it
authors.forename: Daniele
authors.initials: D
authors.lastname: Focosi
authors.forename: Matteo
authors.initials: M
authors.lastname: Pelosini
authors.forename: Piero
authors.initials: P
authors.lastname: Palla
authors.forename: Sara
authors.initials: S
authors.lastname: Galimberti
authors.forename: Francesco
authors.initials: F
authors.lastname: Caracciolo
authors.forename: Edoardo
authors.initials: E
authors.lastname: Benedetti
authors.forename: Federico
authors.initials: F
authors.lastname: Papineschi
authors.forename: Mario
authors.initials: M
authors.lastname: Petrini
mesh_terms: 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
chemical_list: D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan