Alkylating Agents

A 52-year-old man with multiple myeloma is started on high-dose melphalan followed by autologous stem cell transplantation. Which is the most common acute hematological toxicity expected within the first 2–3 weeks post-transplantation?

A 52-year-old man with newly diagnosed multiple myeloma presents to the oncology clinic. He is planned for induction therapy with bortezomib and dexamethasone followed by high-dose melphalan with autologous stem cell transplantation. Before initiating melphalan, which investigation is most appropriate to assess the risk of treatment-related toxicity and guide dose modification?

A 52-year-old woman with newly diagnosed multiple myeloma presents to the oncology clinic. She has been started on a combination chemotherapy regimen including an alkylating agent. After 3 months of therapy, she develops severe bone marrow suppression with a hemoglobin of 7.2 g/dL, WBC 2100/μL, and platelets 45,000/μL. Additionally, she reports dysuria and hematuria. Urinalysis shows RBCs and WBCs in the urine. Which alkylating agent is most likely responsible for this constellation of findings, and what is the primary mechanism of its urinary toxicity?

A 48-year-old man with Hodgkin lymphoma (stage IIIB) is initiated on ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine). After the second cycle, he develops severe nausea, vomiting, and mucositis. Laboratory studies show a creatinine of 1.8 mg/dL (baseline 0.9) and uric acid of 12.2 mg/dL. He has not received adequate prophylaxis. Which component of the ABVD regimen is the alkylating agent, and what is the primary mechanism of its nephrotoxicity in this clinical context?

A 52-year-old man with newly diagnosed multiple myeloma is being evaluated for chemotherapy. His baseline renal function shows creatinine 1.8 mg/dL and eGFR 42 mL/min/1.73m². Before initiating melphalan-based therapy, which investigation is most important to assess the risk of severe alkylating agent toxicity?