Melphalan
- PDF / 171,090 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 19 Downloads / 173 Views
1 S
Oral mucositis: case report An approximately 61-year-old woman developed oral mucositis during treatment with melphalan. The woman, in May 2017 at the age of 60 years was admitted for proteinuria. She had a history of arterial hypertension, which was treated with pharmacotherapy and chronic venous insufficiency of the lower extremities. She had also undergone a right-sided oophorectomy for a cyst many years ago. Following hospital admission, based on kidney biopsy result, she was diagnosed with focal and segmental glomerulosclerosis. She started receiving prednisone followed by methylprednisolone. After 2 months of the treatment, her proteinuria decreased. However, within a month, she exhibited increase in proteinuria despite methylprednisolone treatment. In October 2017, treatment was started with ciclosporin; however, no clinical response was noted. In January 2018, she was diagnosed with hypoproteinaemia, hypo-albuminaemia, hyperlipidaemia and vitamin-D deficiency. She also exhibited orthostatic hypotension. She was switched to mycophenolate-mofetil; however, no reduction in proteinuria was noted. In February 2018, based on repeat renal biopsy results, she was diagnosed with amyloid light-chain (AL) amyloidosis. In May 2018, she was admitted at haematology department. On the basis of the clinical evaluation and the results of all diagnostic tests, a diagnosis of AL amyloidosis with isolated kidney involvement, stage II was established. She was scheduled to receive melphalan [HD-Mel] therapy with autologous haematopoietic stem cell transplantation (auto-HSCT) consolidation. As she had low percentage of clonal plasmocytes, a decision was made to perform mobilisation of the stem cells with granulocyte colony-stimulating factor. During stem cell mobilisation, she received filgrastim for 4 days. On 25 June 2018, the stem cell separation procedure was performed. At that time no complications were noted. On 26 June 2018, she received intravenous melphalan infusion 200 mg/m2 of body surface area (total dose of the drug 350mg) for conditioning prior to auto-HSCT. On 27 June 2018, she underwent auto-HSCT. During the posttransplant period, she developed pancytopenia with agranulocytosis. On day 8 after auto-HSCT, she developed acute renal failure with anuria and massive oedema of the lower limbs. Therefore, she received treatment with forced diuresis including furosemide and manitol. She received albumin supplementation as well. Subsequently, she exhibited clinical improvement. She had also developed exacerbated symptoms of oral mucositis, grade III secondary to melphalan [duration of treatment to reaction onset not stated]. The woman received analgesic treatment with morphine [outcome not stated]. Post-auto HSCT, she developed hypotension, several episodes of atrial fibrillation, diarrhoea and pneumonia resulting in transient respiratory failure. Following treatment, her condition improved and she was discharged on 19 July 2018 in a good condition. Konska A, et al. Complications of autologous hematopoietic stem cell
Data Loading...
