MULTIORGAN DYSFUNCTION ASSOCIATED WITH HIGH-DOSE CARBOPLATIN THERAPY PRIOR TO AUTOLOGOUS TRANSPLANTATION

The specific contribution of high-dose carboplatin to regimen-related toxicity after autologous transplantation has been difficult to determ ine, particularly in patients receiving cyclophosphamide or ifosfamide . We report five cases of severe multi-system failure in patients rece iving high-dose carboplatin in addition to other cytotoxics prior to a utologous transplantation. Two of these patients did not receive ifosf amide or cyclophosphamide as part of their chemotherapy. The clinical picture consisted of early onset acute renal failure, arrhythmias and/ or myocardial hypokinesia, mental obtundation and other neurological d eficits and, in two patients, an acute myopathy. In the two patients i n whom serum platinum was measured, levels were very high at the time of marrow infusion. All patients had received prior cisplatin therapy but showed either normal or only modestly impaired creatinine clearanc e before the transplant. These observations are consistent with a spec ific clinical syndrome associated with carboplatin toxicity and sugges t that creatinine clearance may be inadequate as an indicator of poten tial renal failure when high-dose carboplatin is used.