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A case of melphalan sustained accumulation in an 80-year old patient

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Abstract

Case We report the case of melphalan accumulation in an 80-year old female with multiple myeloma. Her initial health status was good except for a moderate chronic renal failure (estimated glomerular filtration rate: 31 ml/min) and anemia. Among other drugs, her usual treatment included trimethoprim/sulfamethoxazole and the patient received melphalan from day 1 to day 4 for multiple myeloma. On day 13, she was admitted in intensive care unit for acute renal failure and severe sepsis with pancytopenia. Usual treatments were stopped. Melphalan blood concentrations were 123.6 ng/ml on day 16 and 87.5 ng/ml on day 17 while cerebrospinal fluid concentration was 173.8 ng/ml on day 25. Patient recovered on day 30. Melphalan accumulation may be explained by substrate competition between sulfamethoxazole and melphalan in metabolism pathway and chronic renal failure. Conclusion close clinical and renal monitoring should be performed in patient receiving melphalan and sulfamethoxazole.

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Acknowledgments

The authors thank Mrs. Stella Ghouti-Baxter for her linguistic support.

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Authors and Affiliations

  1. Service de Pharmacie, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, 75012, Paris, France

    Pierre-Alain Jolivot, Christine Fernandez & Patrick Hindlet

  2. Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), 75012, Paris, France

    Pierre-Alain Jolivot, Bertrand Guidet, Christine Fernandez & Patrick Hindlet

  3. Gustave Roussy Cancer Campus - Service interdépartemental de Pharmacologie et d’Analyse du Médicament (SIPAM), 94800, Villejuif, France

    Vianney Poinsignon & Angelo Paci

  4. Service de Réanimation médicale, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, 75012, Paris, France

    Bertrand Guidet & Claire Pichereau

  5. Faculté de Pharmacie, Université Paris-Sud, 92290, Chatenay-Malabry, France

    Christine Fernandez & Patrick Hindlet

Authors
  1. Pierre-Alain Jolivot
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  2. Vianney Poinsignon
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  3. Angelo Paci
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  4. Bertrand Guidet
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  5. Claire Pichereau
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  6. Christine Fernandez
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  7. Patrick Hindlet
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Corresponding author

Correspondence to Pierre-Alain Jolivot.

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Jolivot, PA., Poinsignon, V., Paci, A. et al. A case of melphalan sustained accumulation in an 80-year old patient. Int J Clin Pharm 37, 984–987 (2015). https://doi.org/10.1007/s11096-015-0197-x

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  • DOI: https://doi.org/10.1007/s11096-015-0197-x

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