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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.
AuthorsDaniele Focosi, Matteo Pelosini, Piero Palla, Sara Galimberti, Francesco Caracciolo, Edoardo Benedetti, Federico Papineschi, Mario Petrini
JournalTransplant immunology (Transpl Immunol) Vol. 21 Issue 4 Pg. 240-3 (Sep 2009) ISSN: 1878-5492 [Electronic] Netherlands
PMID19539028 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Tumor Necrosis Factor-alpha
  • Melphalan
Topics
  • Brain Diseases, Metabolic (blood, diagnosis, etiology, physiopathology, therapy)
  • Coma
  • Female
  • Hematopoietic Stem Cell Transplantation (adverse effects)
  • Humans
  • Melphalan (administration & dosage, adverse effects)
  • Middle Aged
  • Multiple Myeloma (physiopathology, therapy)
  • Plasma Exchange
  • Renal Dialysis
  • Renal Insufficiency (prevention & control)
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha (adverse effects, blood)

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