Abstract | OBJECTIVE: PATIENTS AND METHODS: Eight patients (mean age, 60.4+/-8.8 years) were treated with cyclic VAD until the disappearance of M- protein from both serum and urine. Of these, seven showed nephrotic syndrome before the start of VAD irrespective of a decrease in creatinine clearance. Serial follow-up studies after VAD evaluated hematological status and organ function. RESULTS: Four patients (50%) showed a marked decrease in abnormal plasma cells in the bone marrow and normalized kappa/lambda ratios of serum free light chain in conjunction with disappearance of M- protein after 1 to 3 courses of VAD. There were no serious adverse events, and nephrotic syndrome gradually improved with no hematological relapse in the follow-up period of 3 to 5 years. The remaining 4 patients showed worsening of congestive heart failure and/or systemic edema ascribable to dexamethasone, resulting in cessation of cyclic VAD before disappearance of M- protein. All of these patients died of multiple organ failure or required permanent hemodialysis within 1 year after the start of cyclic VAD. CONCLUSION: Cyclic VAD is a potent therapeutic option in primary systemic AL amyloidosis, but in patients with renal or cardiac dysfunction careful management for adverse events, especially body fluid retention, is necessary.
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Authors | Ko-Ichi Tazawa, Masayuki Matsuda, Takuhiro Yoshida, Takahisa Gono, Nagaaki Katoh, Yasuhiro Shimojima, Wataru Ishii, Tomohisa Fushimi, Jun Koyama, Shu-Ichi Ikeda |
Journal | Internal medicine (Tokyo, Japan)
(Intern Med)
Vol. 47
Issue 17
Pg. 1517-22
( 2008)
ISSN: 1349-7235 [Electronic] Japan |
PMID | 18758127
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Myeloma Proteins
- multiple myeloma M-proteins
- Vincristine
- Dexamethasone
- Doxorubicin
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Topics |
- Aged
- Amyloidosis
(blood, drug therapy, mortality)
- Antineoplastic Combined Chemotherapy Protocols
(administration & dosage)
- Dexamethasone
(administration & dosage)
- Doxorubicin
(administration & dosage)
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Myeloma Proteins
(antagonists & inhibitors)
- Prospective Studies
- Survival Rate
(trends)
- Treatment Outcome
- Vincristine
(administration & dosage)
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