Analysis of the association of adverse reactions with relative dose of melphalan and body weight in POEMS syndrome patients undergoing melphalan-based ASCT

doi:10.19803/j.1672-8629.20230292

Abstract

Abstract: Objective To analyze the association of adverse reactions and the dose per actual body weight（ABW）of melphalan hydrochloride for injection in POEMS patients undergoing melphalan-based autologous stem cell transplantation (ASCT) and provide reference for clinical drug dose adjustment. Methods The clinical data of five patients with POEMS syndrome undergoing melphalan-based ASCT in the Department of Hematology of Xuanwu Hospital was analyzed retrospectively, to summary the adverse reactions and explore the association of those with relative dose of melphalan. Results One low-body-weight patient was given melphalan calculated based on BSA, with relative melphalan dose of 5.45 mg·kg^-1, had normal renal function, grade one oral mucositis(OM) and grade three drug-induced intestinal disaese(DID). Neutrophil engraftment occured on day +10, platelet on day +11. Three normal-body-weight patients were given melphalan calculated based on ABW, with relative melphalan dose of 4.44~5.41 mg·kg^-1, had normal renal function, no( two patients) and grade two (one patient) OM, grade one, two and three DID, respectively. Neutrophil engraftment occured on day +11~+13, platelets on day +11~+13. One overweight patient with ABW of 130% ideal body weight(IBW), was given melphalan calculated based on IBW, with relative melphalan dose of 4.22 mg·kg^-1, had renal insufficiency because of stem cell mixed with much lysed erythrocyte, grade three OM and grade two DID. Neutrophil engraftment occured on day +11, platelet on day +12. Conclusion In POEMS patients undergoing melphalan-based ASCT, high relative dose of melphalan and renal insufficiency may increase the grade of OM and DID, and may not affect neutrophil and platelet engraftment. Whether body weight based dose adjustment of melphalan is necessary with adequate precautions in overweight patients still need more clinical data to be verified.

Key words: melphalan, relative dose, POEMS syndrome, autologous stem cell transplantation, oral mucositis, drug adverse reactions

CLC Number:

R961

ZOU Dongmei, FANG Fang, GUO Yixian, NI Jing, ZHAO Hong, HU Ronghua, SUN Wanling. Analysis of the association of adverse reactions with relative dose of melphalan and body weight in POEMS syndrome patients undergoing melphalan-based ASCT[J]. Chinese Journal of Pharmacovigilance, 2023, 20(8): 911-914.

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