Table 1. Clinical findings of 3 patients who diagnosed CSW after PBSCT.
| Variable | Patient 1 | Patient 2 | Patient 3 |
|---|---|---|---|
| Sex/age (yr) | M/16 | F/16 | M/15 |
| Primary disease | AML, FLT3-ITD | ALL, Ph | AML, FLT3-ITD |
| Risk classificationa) | High risk | High risk | High risk |
| Conditioning drugs | Busulfan, Fludarabine, ATG | Cyclophosphamide, ATG | Busulfan, Fludarabine, ATG |
| TBI (cGy) | Not doneb) | 1,320 | Not done |
| Immunosuppressionc) | Yes | Yes | Yes |
| Onset of fever (PTD) | 30 | 1 | 18 |
| Etiology of infection | Klebsiella pneumoniae | Cytomegalovirus | Meningitis |
| Engraftment (PTD) | 14 | 12 | 12 |
| Onset of N/C (PTD) | 35 | 19 | 19 |
| Characteristics of N/C | Disorientation, amnesia, confusion | Disorientation, amnesia | Headache, drowsy, personality change |
| Onset of hyponatremia (PTD) | 37 | 19 | 22 |
| CSW diagnosis (PTD) | 38 | 54 | 23 |
| Weight loss, kg (%) | 7.5 (14) | 6 (15) | 5 (8) |
| Maximal U/O (L/m2/day) | 9.7 | 4.0 | 3.2 |
| Fluid balance at diagnosis (L/day) | -2.0 | -1.6 | -1.0 |
| Serum Na (mEq/L) | 114 | 126 | 127 |
| Serum Osm (mOsm/kg) | 240 | 266 | 266 |
| Urine Na (mEq/L) | 217 | 121 | 114 |
| Urine Osm (mOsm/kg) | 513 | 311 | 578 |
| Pro BNP (pg/mL), (ref., <84) | 534 | - | 401.1 |
| BNP (pg/mL), (ref., <100) | - | 154.0 | - |
| ADH (pg/mL), (ref., 0.0-6.7) | 4.3 | 6.0 | 5.5 |
| Renin activity (ng/mL/hr), (ref., 0.3-2.9) | 0.01 | 0.2 | 0.17 |
| Cortisold) | 22.4 | 2.5 | N/A |
| TSH (mIU/L), (ref., 0.2-4.1) | 2.2 | 0.9 | 0.5 |
| Free T4 (ng/dL), (ref., 0.9-1.9) | 1.3 | 1.1 | 1.8 |
| Response of fluid restriction | Not improved | Not improved | Not improved |
| Use of FC (dose, mg) | Yes (0.1-0.2) | Not used | Not used |
CSW, cerebral salt wasting; PBSCT, peripheral blood stem cell transplantation; AML, acute myeloid leukemia; FLT3/ITD, fms-like tyrosine kinase 3-internal tandem duplication; Ph, philadelphia; ATG, antithymocyte globulin; TBI, total body irradiation; PTD, posttransplants day; N/C, neurologic complications; U/O, urine output; Osm, osmolality; BNP, brain natriuretic peptide; ref., reference range; ADH, antidiuretic hormone; N/A, not available; TSH, thyroid stimulating hormone; Free T4, free thyroxine; FC, fludrocortisone.
a)The patients were classified into prognostic risk groups according to the National Comprehensive Cancer Network guidelines. b)This is his 2nd transplant, but he was received TBI when at the time of first transplant. c)The immunosuppression regimen were cyclosporine with methotrexate in all patients. d)Reference value of cortisol was 9.41-26.06 at morning (patient 1) and 1.81-12.67 at evening (patient 2).