Online First

Case Report
Melphalan-associated encephalopathy following autologous stem cell transplant: a transplanter’s nightmare!
Suchita Shinde1, Vinay Anand Guntiboina1, Arijit Nag1, Dibakar Podder1, Debranjani Chattopadhyay1, Jeevan Kumar1, Saurabh Bhave1, Deepak Kumar Mishra2, Mammen Chandy1, Reena Nair1

1 Department of Clinical Haematology and Cellular Therapies, Tata Medical Center, Kolkata, India

2 Department of Laboratory Haematology, Tata Medical Center, Kolkata, India

Melphalan, Encephalopathy, Multiple Myeloma, Chronic Kidney Disease, Autologous Stem Cell Transplant
Submitted:September 1, 2023
Accepted:November 25, 2023
Published online:March 15, 2024


Melphalan-induced encephalopathy is a rare complication observed in patients undergoing autologous stem cell transplantation (ASCT) and is characterized by symptoms ranging from drowsiness to seizures. Previous reports have described similar cases, including a review of a large cohort of patients in whom melphalan-associated encephalopathy was identified in 2% of the patients undergoing ASCT. We describe the case of a 63-year-old male with Multiple Myeloma and underlying chronic kidney disease (CKD) who underwent ASCT with a reduced dose of melphalan due to renal dysfunction in complete remission following induction therapy and subsequent neurological deterioration, which necessitated an extensive evaluation of several neurological and infective etiologies. In this report, we highlight that melphalan-associated encephalopathy is a distinct entity complicating ASCT in patients with myeloma, especially in those with preexisting renal insufficiency, and consider its management.



Online ISSN:2432-7026