Melphalan
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Pancytopenia: case report A 60-year-old man developed pancytopenia during treatment with melphalan. The man, who had a history of hypothyroidism, myocardial infarction, κ-light chain multiple myeloma, and blurry vision post pituitary macroadenoma resection 4 years ago, had been scheduled to undergo auto-hematopoietic cell transplantation. He had been receiving levothyroxine sodium [levothyroxine] for hypothyroidism. He received unspecified induction chemotherapy and underwent auto-hematopoietic cell transplantation with conditioning treatment including IV melphalan 140 mg/m2. His baseline laboratory tests revealed haemoglobin 11.6 g/dL, platelet count 107 x 103 /mcL and leucocyte count 4.5 x103 /mcL. His pancytopenia was considered secondary to the melphalan treatment during hospitalisation [duration of treatment to reaction onset not stated]. On day 9 following transplantation, he developed nausea, headache, retro-orbital pain and bilious vomiting. Later, he developed vision loss in his left eye. An ophthalmic examination showed cupping/pallor of the left optic disc. His BP was 140/80mm Hg. A brain MRI revealed haemorrhagic suprasellar mass without hydrocephalus, midline shift or local mass effect, consistent with haemorrhagic pituitary apoplexy. The man was treated with unspecified steroids. Over the next 2 days, he remained pancytopenic. He developed progressive lethargy with worsening pituitary haemorrhage. Hence, he underwent an endonasal transsphenoidal resection of the pituitary mass. Pathology revealed a gonadotropin-producing pituitary adenoma with haemorrhage. His headache resolved, and his mental status and pancytopenia improved. One month after transplantation, his vision was stable. Patel A, et al. Pituitary Apoplexy During Hematopoietic Cell Transplantation. Clinical Lymphoma, Myeloma & Leukemia 20: e691-e693, No. 10, Oct 2020. Available from: URL: http://doi.org/10.1016/j.clml.2020.05.015 803517891
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Reactions 28 Nov 2020 No. 1832
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