Yamamoto R, Kanda Y, Matsuyama T, Oshima K, Nannya Y, Suguro M, Chizuka A, Hamaki T, Takezako N, Miwa A, Kami M, Mori S, Kojima T, Saito K, Itaoka Y, Kashida M
Department of Hematology, National Cancer Center Hospital, Tokyo, Japan.
Bone Marrow Transplant. 2000 Sep;26(6):685-8. doi: 10.1038/sj.bmt.1702592.
Cyclophosphamide (CPA) is widely used for peripheral blood stem cell mobilization, and a dose adjustment of CPA in the presence of renal failure has not been suggested. However, we describe a myeloma patient with renal failure (serum creatinine 4.2 mg/dl, creatinine clearance 11.2 ml/min) receiving CPA 2 g/m2 for 2 days, who developed unexpectedly severe toxicity, including myopericarditis and prolonged myelosuppression. The serial serum concentrations of CPA metabolites were persistently much higher than those in a myeloma patient with normal renal function. We consider, therefore, that the dose of CPA should be reduced in the presence of severe renal failure when used as high-dose therapy or to mobilize peripheral blood stem cells.
