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TOXIC NEPHROSIS AND MASSIVE HEPATIC NECROSIS PRODUCED BY URETHAN

JOHN F. FLANAGAN, M.D.
AMA Arch Intern Med. 1955;96(2):277-280. doi:10.1001/archinte.1955.00250130151014.
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URETHAN since 1946 has been used extensively in the treatment of multiple myeloma with a good palliative response in somewhat more than 50% of the cases. The margin of safety in the use of this chemotherapeutic agent has appeared to be fairly broad. Moderate leucopenia and gastrointestinal symptoms are the most frequent complications. Rare reports have appeared of agranulocytosis and aplastic anemia in patients on urethan, and reversible central nervous system symptoms have been described, with improvement following cessation of therapy.6 In the past few years convincing evidence has accumulated from both experimental and clinical data indicating that in the dosage range required for effective therapy urethan may occasionally produce massive hepatic necrosis.* Five cases of acute massive centrilobular liver necrosis in patients with multiple myeloma on this treatment have been reported in the last five years.† Findings suggestive of renal damage produced by urethan have been reported in

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