Febrile reactions occurring with second cycle of high-dose melphalan and SCT in patients with AL amyloidosis: a 'melphalan recall' reaction.
Febrile reactions occurring with second cycle of high-dose melphalan and SCT in patients with AL amyloidosis: a 'melphalan recall' reaction.
复制标题
AL 淀粉样变性患者第二周期大剂量美法仑和 SCT 时发生发热反应：“美法仑回忆”反应。
DOI：
10.1038/bmt.2009.94
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发表时间：
2010
影响因子：
4.8
通讯作者：
Sanchorawala,V
中科院分区：
文献类型：
--
作者：
Rosenzweig,M;Seldin,DC;Remick,DG;Skinner,M;Quillen,K;Oran,B;Finn,KT;Sanchorawala,V
高剂量静脉注射美法仑后行自体SCT（HDM/SCT）的积极治疗可有效诱导血液学和临床缓解，并延长AL淀粉样变性患者的生存期。HDM/SCT的串联周期已被证明可增加AL淀粉样变性患者的血液学完全缓解率。1994年4月至2008年7月，波士顿大学医学中心的57例AL淀粉样变性患者在首次移植后未能达到完全缓解后接受了第二周期HDM/SCT治疗。共11例（19%）的57例接受双移植治疗的患者在马法兰给药后12-24小时出现高热。平均峰值温度为39.1 ℃。其他临床特征包括低血压、急性肾衰竭和皮疹。未发现感染性病因。其中1例患者在发热反应之前、期间和之后有血清可用于测量细胞因子。几种促炎细胞因子（包括IL-6和TNFα）的浓度显著升高，显示出与临床结果相关的明显生理反应。我们的结论是，一个不寻常的精氨酸介导的发热反应可能发生在AL淀粉样变性患者暴露于第二个周期的高剂量美法仑，我们称之为“美法仑回忆”反应。
Aggressive treatment with high-dose iv melphalan followed by auto-SCT (HDM/SCT) is effective in inducing hematological and clinical remissions, and in extending survival in AL amyloidosis. Tandem cycles of HDM/SCT have been shown to increase hematologic complete response rates in patients with AL amyloidosis. Between April 1994 and July 2008, 57 patients with AL amyloidosis at the Boston University Medical Center were treated with a second cycle of HDM/SCT after failing to achieve a complete response after a first transplantation. A total of 11 of 57 patients (19%) treated with tandem transplantation developed high fever 12–24 h after melphalan administration. The average peak temperature was 39.1 C. Other clinical features include hypotension, acute renal failure and skin rash. No infectious etiology was identified. One of the patients had serum available for measurement of cytokines before, during and after the febrile reaction. The concentration of several pro-inflammatory cytokines, including IL-6 and TNFα, increased significantly, showing a clear physiological response correlating with the clinical findings. We conclude that an unusual cytokine-mediated febrile reaction can occur in patients with AL amyloidosis exposed to a second cycle of high-dose melphalan, which we have termed a ‘melphalan recall’reaction.