HIGH-DOSE INTRAVENOUS MELPHALAN IN A PATIENT WITH MULTIPLE-MYELOMA AND OLIGURIC RENAL-FAILURE

A kappa light-chain myeloma was diagnosed as the underlying disease in a 52-year-old woman with acute oliguric renal failure. The patient wa s erroneously treated with high-dose intravenous melphalan (60 mg/m(2) ). Because of this overdose treatment with granulocyte colony-stimulat ing factor was initiated, but pronounced absolute leukopenia (white bl ood cell count < 0.5 x 10(9)/l) developed and lasted for 13 days. Foll owing melphalan treatment a continuous increase in urine volume was ac companied by a decrease of serum creatinine and blood urea nitrogen. W ithin 10 days after the administration of melphalan the patient no lon ger required hemodialysis. We conclude that high-dose chemotherapy in combination with hematopoietic growth factors should be considered in individual cases with newly diagnosed light-chain nephropathy.