Division of Hematology, Department of Oncology, Transplants and Advances in Medicine, University of Pisa, Italy.
Transpl Immunol. 2009 Sep;21(4):240-3. doi: 10.1016/j.trim.2009.06.002. Epub 2009 Jun 16.
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.
我们在此报告一例 50 岁女性，患有多发性骨髓瘤相关慢性肾衰竭，接受大剂量化疗支持下的自体造血干细胞移植。她在第 5 天出现进行性脑病，进展为昏迷，尽管进行了血液透析，但无明显器官衰竭。在单次 1 升血浆置换后，她最终恢复。最终诊断为高细胞因子血症引起的代谢性脑病，特别是高血清 TNF 水平。我们在此讨论其发病机制，并提醒大家监测肾衰竭患者接受大剂量化疗时的细胞因子水平。
