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Fotiou D, Theodorakakou F, Spiliopoulou S, Gavriatopoulou M, Migkou M, Kanellias N, Eleutherakis-Papaiakovou E, Malandrakis P, Dialoupi I, Roussou M, Ntanasis-Stathopoulos I, Terpos E, Dimopoulos MA, Kastritis E. Thrombotic and bleeding complications in patients with AL amyloidosis. Br J Haematol 2024; 204:1816-1824. [PMID: 38321638 DOI: 10.1111/bjh.19331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Abstract
Haemostatic abnormalities and deregulated coagulation are common complications in AL amyloidosis. The relevant risks of thromboembolic and haemorrhagic events have not been thoroughly evaluated. To describe clinically significant thrombotic/haemorrhagic events in 450 consecutive patients with AL amyloidosis. Venous thromboembolic events (VTEs) were reported in 6% and arterial embolic events (AEEs) in 5% of patients, respectively, during a 55-month median follow-up. Lower albumin, lower eGFR, higher BM infiltration, soft tissue involvement, IMiD-based therapy and prior thrombosis were associated with VTE risk. Prior thrombosis was the only independent prognostic variable (HR 9.3, p = 0.001). Coronary arterial disease, prior AEE, 24-h proteinuria and higher platelet counts were associated with AEE risk. Significant bleeding events were reported in 9%, and associated mortality was 19%. Liver involvement, higher serum creatinine and higher baseline VWF:Ag levels were linked to bleeding risk. Using competing risk analysis, the cumulative probability of thrombosis/bleeding was higher during the first year following diagnosis, but a stable lower risk for both events remained for the duration of follow-up. In AL amyloidosis patients, the risk of thrombotic/arterial embolic events is significant, but the bleeding risk is also high. A multiparametric assessment is required to initiate anti-thrombotic or anti-platelet therapy appropriately.
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Affiliation(s)
- Despina Fotiou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotiria Spiliopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Magdalini Migkou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kanellias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagiotis Malandrakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Dialoupi
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Roussou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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Oubari S, Naser E, Papathanasiou M, Luedike P, Hagenacker T, Thimm A, Rischpler C, Kessler L, Kimmich C, Hegenbart U, Schönland S, Rassaf T, Reinhardt HC, Jöckel KH, Dürig J, Dührsen U, Carpinteiro A. Impact of time to diagnosis on Mayo stages, treatment outcome, and survival in patients with AL amyloidosis and cardiac involvement. Eur J Haematol 2021; 107:449-457. [PMID: 34185342 DOI: 10.1111/ejh.13681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study the impact of time to diagnosis on cardiac Mayo stages, treatment outcome, and overall survival. METHODS We retrospectively analyzed 77 consecutive patients diagnosed between 2015 and 2020 with AL amyloidosis and cardiac involvement. Medical history was recorded in standardized form with the help of a questionnaire. RESULTS Time from onset of symptoms of cardiac failure to diagnosis was correlated with the severity of cardiac involvement in modified Mayo 2004 and revised Mayo 2012 staging systems (rs = 0.30, 95% CI: 0.07-0.50, P = .007 and rs = 0.25, 95% CI: 0.01-0.45, P = .03). Patients with advanced Mayo 2004 stages received reduced-intensity regimens and had a lower probability to achieve adequate hematologic- and cardiac response after first-line treatment than patients with early stages (rs = 0.28, 95% CI: 0.04-0.48, P = .01 and rs = 0.72, 95% CI: 0.55-0.82, P < .0001) and poorer overall survival (P = .0004). Compared with patients diagnosed within the first year, patients diagnosed after 13-18 or ≥19 months from first symptoms had a 3- to 5 times higher risk of dying. Our data indicate that there is a 12-month window within which the diagnosis of AL amyloidosis needs to be established to avoid early deterioration and death. CONCLUSIONS Sensitizing physicians and raising awareness for the disease are crucial for timely diagnosis and may improve the outcome of the disease.
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Affiliation(s)
- Sara Oubari
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany.,Interdisciplinary Amyloidosis Network, University Hospital Essen, Essen, Germany
| | - Eyad Naser
- Institute of Molecular Biology, University of Duisburg-Essen, Essen, Germany
| | - Maria Papathanasiou
- Interdisciplinary Amyloidosis Network, University Hospital Essen, Essen, Germany.,Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Peter Luedike
- Interdisciplinary Amyloidosis Network, University Hospital Essen, Essen, Germany.,Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Tim Hagenacker
- Interdisciplinary Amyloidosis Network, University Hospital Essen, Essen, Germany.,Department of Neurology, University Hospital Essen, Essen, Germany
| | - Andreas Thimm
- Interdisciplinary Amyloidosis Network, University Hospital Essen, Essen, Germany.,Department of Neurology, University Hospital Essen, Essen, Germany
| | - Christoph Rischpler
- Interdisciplinary Amyloidosis Network, University Hospital Essen, Essen, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Lukas Kessler
- Interdisciplinary Amyloidosis Network, University Hospital Essen, Essen, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Christoph Kimmich
- Department of Hematology and Oncology, Oldenburg Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Ute Hegenbart
- Department of Internal Medicine V, Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Schönland
- Department of Internal Medicine V, Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Hans Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Jan Dürig
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Ulrich Dührsen
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Alexander Carpinteiro
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany.,Interdisciplinary Amyloidosis Network, University Hospital Essen, Essen, Germany.,Institute of Molecular Biology, University of Duisburg-Essen, Essen, Germany
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3
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Panse G, Subtil A, McNiff JM, Glusac EJ, Ko CJ, Galan A, Myung P, Xu ML. Cutaneous Involvement in Plasma Cell Myeloma. Am J Clin Pathol 2021; 155:106-116. [PMID: 32885235 DOI: 10.1093/ajcp/aqaa122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Plasma cell myeloma (PCM) involving skin is rare and occurs in 1% to 4% of patients with PCM. We evaluated the clinicopathologic features, cytogenetic findings and clinical follow-up in a series of PCM cases with cutaneous involvement. METHODS Cases of PCM with cutaneous involvement were retrospectively reviewed with clinical data. RESULTS Skin involvement in PCM occurred in older individuals (mean, 75 years) and was more frequent in men (7/10 patients). All cases showed bone marrow involvement preceding the cutaneous lesions. Histopathologically, the infiltrate was plasmacytic (n = 5) or primitive or plasmablastic (n = 4), and 1 case showed predominantly lymphoplasmacytic features with cyclin D1 immunoreactivity and CCND1 gene rearrangement. Concurrent amyloid deposition was seen in one biopsy, and another case demonstrated coexisting squamous cell carcinoma. The most common immunophenotype was CD138+, CD20-, and CD56+ with light chain restriction. Cytogenetic analysis (available for 7 cases) showed multiple hyperdiploid abnormalities. Follow-up was available for 8 cases (mean, 42 months; range, 11-156 months) and showed short-term disease-related death in 7 of 8 patients. CONCLUSIONS Cutaneous involvement in PCM demonstrates a diverse cytomorphologic spectrum with plasmacytic, plasmablastic, or lymphoplasmacytic features and may show concurrent amyloid deposition or neoplasms such as squamous cell carcinoma. Cutaneous involvement typically occurs late in the course of the disease and likely portends poor outcome.
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Affiliation(s)
- Gauri Panse
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Antonio Subtil
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Jennifer M McNiff
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Earl J Glusac
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Christine J Ko
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Anjela Galan
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Peggy Myung
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Mina L Xu
- Department of Pathology, Yale School of Medicine, New Haven, CT
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Ozga M, Zhao Q, Benson D, Elder P, Williams N, Bumma N, Rosko A, Chaudhry M, Khan A, Devarakonda S, Kahwash R, Vallakati A, Campbell C, Parikh SV, Almaani S, Prosek J, Bittengle J, Pfund K, LoRusso S, Freimer M, Redder E, Efebera Y, Sharma N. AL amyloidosis: The effect of fluorescent in situ hybridization abnormalities on organ involvement and survival. Cancer Med 2020; 10:965-973. [PMID: 33347707 PMCID: PMC7897960 DOI: 10.1002/cam4.3683] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/17/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background Systemic light chain (AL) amyloidosis is a clonal plasma‐cell neoplasm that carries a poor prognosis. Although AL amyloidosis and Multiple Myeloma (MM) can co‐exist and share various cytogenetic chromosomal abnormalities, little is known about Fluorescent in situ hybridization (FISH) and its prognostic relevance in AL amyloidosis. Aim: The study aims to evaluate the most prevalent FISH cytogenetic abnormalities in AL patients as independent prognostic factors, and assess the impact of cytogenetics on the survival of high‐risk cardiac AL patients. Materials & Methods This retrospective study reviewed 113 consecutive AL patients treated at The Ohio State University (OSU). Patients were divided into subgroups based on FISH data obtained within 90 days of diagnosis. Hyperdiploidy was defined as trisomies of at least 2 chromosomal loci. Primary endpoints were progression free survival (PFS) and overall survival (OS). Kaplan Meier curves were used to calculate PFS and OS. The log‐rank test and Cox proportional hazard models were used to test the equality of survival functions and further evaluate the differences between groups. Results FISH abnormalities were detected in 76% of patients. Patients with abnormal FISH trended toward lower overall survival (OS) (p=0.06) and progression free survival (PFS) (p=0.06). The two most prevalent aberrations were translocation t(11;14) (39%) and hyperdiploidy‐overall (38%). Hyperdiploidy‐overall was associated with worsening PFS (p=0.018) and OS (p=0.03), confirmed in multivariable analysis. Patients with del 13q most frequently had cardiac involvement (p=0.006) and was associated with increased bone marrow plasmacytosis (p=0.02). Cardiac AL patients with no FISH abnormalities had much improved OS (p=0.012) and PFS (p=0.018) Conclusions Our findings ultimately reveal the association of hyperdiploidy on survival in AL amyloidosis patients, including the high‐risk cardiac AL population.
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Affiliation(s)
- Michael Ozga
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Qiuhong Zhao
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Don Benson
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Patrick Elder
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Nita Williams
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Naresh Bumma
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Ashley Rosko
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Maria Chaudhry
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Abdullah Khan
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Srinivas Devarakonda
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Rami Kahwash
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ajay Vallakati
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Courtney Campbell
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Samir V Parikh
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Salem Almaani
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Jason Prosek
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Jordan Bittengle
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Katherine Pfund
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Samantha LoRusso
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Miriam Freimer
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Elyse Redder
- Department of Oncology Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - Yvonne Efebera
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Nidhi Sharma
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
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5
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Ozga M, Zhao Q, Benson D, Elder P, Williams N, Bumma N, Rosko A, Chaudhry M, Khan A, Devarakonda S, Kahwash R, Vallakati A, Campbell C, Parikh SV, Almaani S, Prosek J, Bittengle J, Pfund K, LoRusso S, Freimer M, Redder E, Efebera Y, Sharma N. AL Amyloidosis: The Effect of Maintenance Therapy on Autologous Stem Cell Transplantation Outcomes. J Clin Med 2020; 9:E3778. [PMID: 33238501 PMCID: PMC7700492 DOI: 10.3390/jcm9113778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/10/2020] [Accepted: 11/20/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) remains an effective treatment option for many patients with systemic light chain (AL) amyloidosis. While maintenance post ASCT in multiple myeloma is now standard, the decision to utilize maintenance in AL amyloidosis remains largely unexplored. The present study aims to determine the prognostic significance of utilizing maintenance therapy following ASCT and assess the impact of fluorescent in situ hybridization (FISH) abnormalities, bone marrow plasma cell burden (BMPC), and degree of organ involvement on this decision. METHODS AND RESULTS This is a retrospective analysis of fifty AL amyloidosis patients who underwent ASCT at The Ohio State University. Twenty-eight patients received maintenance and twenty-two did not. Kaplan-Meier survival analysis was used to compare the effect of maintenance therapy with no significant difference in PFS (p = 0.66) and OS (p = 0.32) between the two groups. There was no difference in survival based on maintenance when further categorized by FISH, PFS (p = 0.15), and OS (p = 0.65); BMPC ≥ 10%, PFS (p = 0.49), and OS (p = 0.32); or with 2 or more organs involved, PFS (p = 0.34) and OS (p = 0.80). CONCLUSION Maintenance therapy post ASCT did not impact PFS or OS when categorized by FISH abnormalities, increasing BMPC, or ≥2 organs involved in AL amyloidosis patients.
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Affiliation(s)
- Michael Ozga
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Don Benson
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Patrick Elder
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Nita Williams
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Naresh Bumma
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Ashley Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Maria Chaudhry
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Abdullah Khan
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Srinivas Devarakonda
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Rami Kahwash
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (R.K.); (A.V.); (C.C.)
| | - Ajay Vallakati
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (R.K.); (A.V.); (C.C.)
| | - Courtney Campbell
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (R.K.); (A.V.); (C.C.)
| | - Samir V. Parikh
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.V.P.); (S.A.); (J.P.)
| | - Salem Almaani
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.V.P.); (S.A.); (J.P.)
| | - Jason Prosek
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.V.P.); (S.A.); (J.P.)
| | - Jordan Bittengle
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Katherine Pfund
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Samantha LoRusso
- Department of Neurology, The Ohio State University, Columbus, OH 43210, USA; (S.L.); (M.F.)
| | - Miriam Freimer
- Department of Neurology, The Ohio State University, Columbus, OH 43210, USA; (S.L.); (M.F.)
| | - Elyse Redder
- Department of Oncology Rehabilitation, The Ohio State University, Columbus, OH 43210, USA;
| | - Yvonne Efebera
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Nidhi Sharma
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
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6
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Naddaf E, Mauermann ML. Peripheral Neuropathies Associated With Monoclonal Gammopathies. Continuum (Minneap Minn) 2020; 26:1369-1383. [DOI: 10.1212/con.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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7
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Schulman A, Connors LH, Weinberg J, Mendelson LM, Joshi T, Shelton AC, Sanchorawala V. Patient outcomes in light chain (AL) amyloidosis: The clock is ticking from symptoms to diagnosis. Eur J Haematol 2020; 105:495-501. [DOI: 10.1111/ejh.13472] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Amanda Schulman
- Amyloidosis Center Boston Medical Center Boston University School of Medicine Boston Massachusetts USA
| | - Lawreen H Connors
- Amyloidosis Center Boston Medical Center Boston University School of Medicine Boston Massachusetts USA
| | - Janice Weinberg
- Department of Biostatistics Boston University School of Public Health Boston Massachusetts USA
| | - Lisa M Mendelson
- Amyloidosis Center Boston Medical Center Boston University School of Medicine Boston Massachusetts USA
| | - Tracy Joshi
- Amyloidosis Center Boston Medical Center Boston University School of Medicine Boston Massachusetts USA
| | - Anthony C Shelton
- Amyloidosis Center Boston Medical Center Boston University School of Medicine Boston Massachusetts USA
| | - Vaishali Sanchorawala
- Amyloidosis Center Boston Medical Center Boston University School of Medicine Boston Massachusetts USA
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8
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Wisniowski B, Wechalekar A. Confirming the Diagnosis of Amyloidosis. Acta Haematol 2020; 143:312-321. [PMID: 32544917 DOI: 10.1159/000508022] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022]
Abstract
Amyloidosis is a general term for diseases characterised by the deposition of insoluble amyloid fibrils in organs or tissues, leading to organ dysfunction and, in many cases, death. Amyloid fibrils are derived from soluble precursor proteins, with the number of known amyloidogenic proteins increasing over time. The identity of the precursor protein often predicts the disease phenotype, although many of the amyloidoses have overlapping clinical features. Most patients with amyloidosis will require biopsy of an involved organ or tissue to confirm the diagnosis. Cardiac transthyretin amyloidosis, however, may be diagnosed without a biopsy provided stringent criteria are met. Where amyloid is confirmed histologically, the identity of the amyloidogenic protein must be determined, given several of the amyloidoses have disease-specific therapies. Laser capture microdissection and tandem mass spectrometry, LCM-MS, has revolutionised amyloid subtyping, being able to identify the amyloidogenic protein more reliably than antibody-based methods such as immunohistochemistry. Here we summarise the biopsy approach to amyloidosis, as well as the non-biopsy diagnosis of cardiac transthyretin amyloidosis. Proteomic and antibody-based methods for amyloid subtyping are reviewed. Finally, an algorithm for confirming the diagnosis of amyloidosis is presented.
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Monoclonal Gammopathy of Undetermined Significance (MGUS)-Not So Asymptomatic after All. Cancers (Basel) 2020; 12:cancers12061554. [PMID: 32545521 PMCID: PMC7352603 DOI: 10.3390/cancers12061554] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022] Open
Abstract
Monoclonal Gammopathy of Undetermined Significance (MGUS) is considered to be a benign precursor condition that may progress to a lymphoproliferative disease or multiple myeloma. Most patients do not progress to an overt condition, but nevertheless, MGUS is associated with a shortened life expectancy and, in a minority of cases, a number of co-morbid conditions that include an increased fracture risk, renal impairment, peripheral neuropathy, secondary immunodeficiency, and cardiovascular disease. This review aims to consolidate current evidence for the significance of these co-morbidities before considering how best to approach these symptoms and signs, which are often encountered in primary care or within a number of specialties in secondary care.
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10
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Fuchida SI, Ide D, Taminishi-Katsuragawa Y, Suga T, Matsui-Maegawa S, Maruyama N, Iwamura Y, Kitamura Y, Okawa Y, Okano A, Hatsuse M, Murakami S, Shimazaki C. A retrospective analysis of treatment outcomes in 45 patients with cardiac light-chain amyloidosis: a single-center experience in Japan. Int J Hematol 2020; 111:803-811. [PMID: 32020505 DOI: 10.1007/s12185-020-02835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 11/27/2022]
Abstract
The prognosis of cardiac light-chain (AL) amyloidosis is considered to be very poor. We studied the treatment efficacy and outcomes by retrospectively analyzing the clinical results of 45 patients with cardiac AL amyloidosis treated at our hospital between September 2008 and March 2016. The group of patients analyzed included 29 males and 16 females with a median age of 68 years. Their baseline median NT-proBNP, cTnT, and dFLC were 3167 pg/ml, 0.080 ng/ml, and 286.17 mg/l, respectively. Twenty-eight patients were in Cardiac Stage (CS) III and 17 patients were in Revised Prognostic Stage (RPS) IV. At the median follow-up of 10 months, the median overall survival (OS) was 16 months and 3-year OS was 35.9%. The patients in CS III showed significantly poorer survival rate than those in CS I or II (3-year OS: 12.2% vs. 65.8%, p = 0.0115) and the patients in RPS IV showed significantly poorer survival rate than those in RPS I, II, or III (3-year OS: 11.0% vs. 53.3%, p = 0.000914). Regardless of the therapeutic approaches, patients who achieved hematological CR or cardiac organ response demonstrated significantly improved prognosis. Therefore, achievement of hematological and organ responses is important in the treatment of cardiac AL amyloidosis.
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Affiliation(s)
- Shin-Ichi Fuchida
- Department of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, 27 Shimofusa-cho, Kita-ku, Kyoto, 603-8151, Japan.
| | - Daisuke Ide
- Department of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, 27 Shimofusa-cho, Kita-ku, Kyoto, 603-8151, Japan
| | - Yoko Taminishi-Katsuragawa
- Department of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, 27 Shimofusa-cho, Kita-ku, Kyoto, 603-8151, Japan
| | - Takaomi Suga
- Department of Cardiology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Saori Matsui-Maegawa
- Department of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, 27 Shimofusa-cho, Kita-ku, Kyoto, 603-8151, Japan
| | - Naoki Maruyama
- Department of Cardiology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Yumi Iwamura
- Department of Cardiology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Yohei Kitamura
- Department of Cardiology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Yoshifumi Okawa
- Department of Cardiology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Akira Okano
- Department of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, 27 Shimofusa-cho, Kita-ku, Kyoto, 603-8151, Japan
- Department of Hematology, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Mayumi Hatsuse
- Department of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, 27 Shimofusa-cho, Kita-ku, Kyoto, 603-8151, Japan
| | - Satoshi Murakami
- Department of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, 27 Shimofusa-cho, Kita-ku, Kyoto, 603-8151, Japan
| | - Chihiro Shimazaki
- Department of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, 27 Shimofusa-cho, Kita-ku, Kyoto, 603-8151, Japan
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11
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Ablasser K, Verheyen N, Glantschnig T, Agnetti G, Rainer PP. Unfolding Cardiac Amyloidosis –From Pathophysiology to Cure. Curr Med Chem 2019; 26:2865-2878. [DOI: 10.2174/0929867325666180104153338] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022]
Abstract
Deposition of amyloidogenic proteins leading to the formation of amyloid fibrils in the myocardium causes cardiac amyloidosis. Although any form of systemic amyloidosis can affect the heart, light-chain (AL) or transthyretin amyloidosis (ATTR) account for the majority of diagnosed cardiac amyloid deposition. The extent of cardiac disease independently predicts mortality. Thus, the reversal of arrest of adverse cardiac remodeling is the target of current therapies. Here, we provide a condensed overview on the pathophysiology of AL and ATTR cardiac amyloidoses and describe treatments that are currently used or investigated in clinical or preclinical trials. We also briefly discuss acquired amyloid deposition in cardiovascular disease other than AL or ATTR.
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Affiliation(s)
- Klemens Ablasser
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Nicolas Verheyen
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | | | - Giulio Agnetti
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Peter P. Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
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12
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Light chain amyloidosis of the lacrimal glands in a patient with chronic dacryoadenitis. Can J Ophthalmol 2019; 54:e163-e166. [DOI: 10.1016/j.jcjo.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 11/21/2022]
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13
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Miyazaki K, Suzuki K. Autologous Hematopoietic Cell Transplantation Versus Chemotherapy Alone for Immunoglobulin Light Chain Amyloidosis: A Retrospective Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:413-422.e5. [DOI: 10.1016/j.clml.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/04/2019] [Accepted: 02/14/2019] [Indexed: 11/28/2022]
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14
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Varga C, Titus SE, Toskic D, Comenzo RL. Use of novel therapies in the treatment of light chain amyloidosis. Blood Rev 2019; 37:100581. [PMID: 31167719 DOI: 10.1016/j.blre.2019.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/26/2019] [Accepted: 05/20/2019] [Indexed: 12/22/2022]
Abstract
Immunoglobulin light-chain (AL) amyloidosis is a rare life-threatening disease caused by light chains that are toxic to vital organs such as the heart, kidneys, liver and peripheral nervous system, and that misfold and assemble as amyloid fibrils and deposit both in affected organs and systemically in the vasculature and other tissues. Patients afflicted by this disease have B-cell disorders, almost always related to clonal plasma cells in the bone marrow, the burden of which can range from small clones involving 5% or less of marrow cells to frank multiple myeloma. The goal of therapy is to eliminate the clonal plasma cells producing these toxic light chains to halt and possibly reverse symptomatic organ damage. While autologous stem cell transplantation can be a very effective treatment modality in AL, it has a limited role due to the frailty of this particular population. Conservative treatment in the form of chemotherapy has become the backbone of therapy. Bortezomib combined with alkylators has proven quite successful in inducing hematologic responses. However, despite these advances, tolerability and resistance continue to be an ongoing issue. Novel anti-plasma cell therapies such as ixazomib, carfilzomib, lenalidomide and pomalidomide are actively being combined and evaluated in clinical trials for efficacy and toxicity in this challenging patient population. Other approaches, such as monoclonal antibodies targeting surface proteins and amyloid deposits, are being tested and combined with novel agents. In this review, we will provide an overview of the clinical trials that have led to current treatment algorithms and will also discuss monoclonal antibodies currently under investigation and in various stages of clinical development.
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Affiliation(s)
- Cindy Varga
- The John Conant Davis Myeloma and Amyloid Program, Division of Hematology-Oncology, Tufts Medical Center, 800 Washington St., Boston, MA 02111, USA; Department of Medicine, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA.
| | - Stephanie E Titus
- Department of Medicine, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA.
| | - Denis Toskic
- The John Conant Davis Myeloma and Amyloid Program, Division of Hematology-Oncology, Tufts Medical Center, 800 Washington St., Boston, MA 02111, USA
| | - Raymond L Comenzo
- The John Conant Davis Myeloma and Amyloid Program, Division of Hematology-Oncology, Tufts Medical Center, 800 Washington St., Boston, MA 02111, USA; Department of Medicine, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA.
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15
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Hsiao PJ, Chang YC, Tsao YH, Wu KL, Kao YH, Chan JS, Wang CH, Lin YY, Chuu CP, Lin YS. Ptosis and macroglossia in a woman with systemic light-chain amyloidosis. Clin Chim Acta 2019; 494:112-115. [PMID: 30905590 DOI: 10.1016/j.cca.2019.03.1624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Amyloidosis is a rare and variable disease, characterized by extracellular deposits of amyloid protein in different tissues and organs. Patients may present with a range of symptoms, depending on the extent of involvement. Rapid, accurate diagnosis is still challenging in clinical practice. CASE REPORT A 72-y-old woman presented with a 1-y history of droopy upper left eyelid, resulting in decreased visual acuity, and progressive tongue swelling, resulting in dysarthria, dysphagia, and sleep apnea. Physical examination revealed puffy eyes, moderate swelling up to 1 cm of the upper left eyelid, swollen submental region, and protrusion of the tongue, causing an inability to close the mouth. An abnormal serum free light chain ratio implied the presence of monoclonal gammopathies, and Congo red staining revealed amyloid deposits in specimens from both the tongue and left eyelid. Therefore, a diagnosis of systemic light-chain (AL) amyloidosis was confirmed. The patient then received oral melphalan therapy and surgical intervention for macroglossia. Clinical symptoms including dysarthria, dysphagia, and sleep apnea were under control at 6-month follow-up. CONCLUSIONS We report an uncommon case presenting initially with both ptosis and macroglossia, for which a final diagnosis of systemic AL amyloidosis was made. Detailed history and laboratory investigation must be implemented on suspicion of amyloidosis, because early recognition of amyloid-associated diseases and appropriate treatment can improve clinical outcomes.
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Affiliation(s)
- Po-Jen Hsiao
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan; Department of Life Sciences, National Central University, Taoyuan City, Taiwan.
| | - Ya-Chieh Chang
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Yuan-Heng Tsao
- Division of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Otolaryngology-Head and Neck Surgery, Taoyuan Armed Forces General Hospital, Taiwan
| | - Kun-Lin Wu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Yung-Hsi Kao
- Department of Life Sciences, National Central University, Taoyuan City, Taiwan
| | - Jenq-Shyong Chan
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Chih-Hung Wang
- Division of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Yue Lin
- Department of Life Sciences, National Central University, Taoyuan City, Taiwan; Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan City, Taiwan
| | - Chih-Pin Chuu
- Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli County, Taiwan; Graduate Program for Aging, China Medical University, Taichung City, Taiwan
| | - Yaoh-Shiang Lin
- Division of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Otolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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16
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Chang IC, Dispenzieri A, Scott CG, Lin G, Jaffe AS, Klarich KW, Grogan M. Utility of the Serum Free Light Chain Assay in the Diagnosis of Light Chain Amyloidosis in Patients With Heart Failure. Mayo Clin Proc 2019; 94:447-454. [PMID: 30718069 DOI: 10.1016/j.mayocp.2018.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/26/2018] [Accepted: 07/31/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the utility of the serum free light chain (FLC) assay for routine screening of light chain amyloidosis (AL) in patients with heart failure. PATIENTS AND METHODS We studied consecutive new patients referred to the Heart Failure Clinic who had the FLC assay performed for routine screening at Mayo Clinic's campus in Rochester, Minnesota, from January 1, 2011, through December 31, 2015. An FLC ratio between 0.26 and 1.65 was considered normal. RESULTS Of the 1173 patients in the study (mean age, 64±15 years), 207 had an abnormal FLC ratio. Light chain amyloidosis was diagnosed in 0.5% of all patients (6 of 1173) and in 2.9% of those with an abnormal FLC ratio (6 of 207). To increase the pretest probability of an abnormal FLC ratio in predicting AL, we considered patients with an N-terminal pro B-type natriuretic peptide level of 5000 pg/mL or greater (to convert to pmol/L, multiply by 0.1182) and a left ventricular posterior wall thickness of 13 mm or greater; this increased the diagnostic yield to 66.7% (6 of 9). CONCLUSION The prevalence of AL in patients with heart failure could be 0.5% or higher. Compared with the use of the serum FLC assay for routine screening, a targeted approach of the serum FLC assay in those with higher N-terminal pro B-type natriuretic peptide level (≥5000 pg/mL) and increased posterior wall thickness (≥13 mm) has a markedly higher yield for the diagnosis of AL.
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Affiliation(s)
- Ian C Chang
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Angela Dispenzieri
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Grace Lin
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Kyle W Klarich
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Martha Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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17
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Luo E, Liu H, Zhao Q, Shi B, Chen Q. Dental-craniofacial manifestation and treatment of rare diseases. Int J Oral Sci 2019; 11:9. [PMID: 30783081 PMCID: PMC6381182 DOI: 10.1038/s41368-018-0041-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 02/05/2023] Open
Abstract
Rare diseases are usually genetic, chronic and incurable disorders with a relatively low incidence. Developments in the diagnosis and management of rare diseases have been relatively slow due to a lack of sufficient profit motivation and market to attract research by companies. However, due to the attention of government and society as well as economic development, rare diseases have been gradually become an increasing concern. As several dental-craniofacial manifestations are associated with rare diseases, we summarize them in this study to help dentists and oral maxillofacial surgeons provide an early diagnosis and subsequent management for patients with these rare diseases.
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Affiliation(s)
- En Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanghang Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qiucheng Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Qianming Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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18
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Aimo A, Buda G, Fontana M, Barison A, Vergaro G, Emdin M, Merlini G. Therapies for cardiac light chain amyloidosis: An update. Int J Cardiol 2018; 271:152-160. [DOI: 10.1016/j.ijcard.2018.05.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 12/11/2022]
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19
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Gareb B, Perry M, Tadrous PJ. Isolated Light Chain Amyloidosis Involving the Parotid Gland: A Case Report. J Oral Maxillofac Surg 2018; 76:1917-1924. [DOI: 10.1016/j.joms.2018.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 11/26/2022]
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20
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Inokuchi R, Tagami S, Maehara H. An elderly woman with bilateral raccoon eyes. Emerg Med J 2018; 33:781. [PMID: 28319930 DOI: 10.1136/emermed-2015-205071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Ryota Inokuchi
- Department of Emergency Medicine, JR General Hospital, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Shunsuke Tagami
- Department of Emergency Medicine, JR General Hospital, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiromu Maehara
- Department of Emergency Medicine, JR General Hospital, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
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21
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Abstract
The heart, like any organ in the body, is susceptible to amyloid deposition. Although more than 30 types of protein can cause amyloidosis, only two types commonly deposit in the ventricular myocardium: amyloid light chain and amyloid transthyretin. Amyloid cardiomyopathy is usually a major determinant of patient outcomes, and the diagnosis of heart involvement can be often relatively under-diagnosed, owing to nonspecific presenting symptoms and signs at a subclinical stage. The diagnosis of cardiac amyloidosis is usually performed by endomyocardial biopsy; however, the invasive nature and related high-risk complications restrict its wide use in clinical settings. Recently, with the advent of innovative techniques used for evaluating cardiac amyloidosis, noninvasive methods become increasingly important, especially in earlier diagnosis, distinguishing typing, risk prediction and response to treatment. Here, we will review recent developments in the noninvasive methods used in the assessment of cardiac amyloidosis, focused on the laboratory biomarkers and imaging modalities.
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Affiliation(s)
- Lei Zhao
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing, Dongcheng district, Beijing, 100730, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing, Dongcheng district, Beijing, 100730, China.
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Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment-A Systematic Review. Radiol Res Pract 2017; 2017:2874902. [PMID: 29270320 PMCID: PMC5705874 DOI: 10.1155/2017/2874902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/02/2017] [Indexed: 12/19/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is the least common among cardiomyopathies. It can be idiopathic, familial, or secondary to systematic disorders. Marked increase in left and/or right ventricular filling pressures causes symptoms and signs of congestive heart failure. Electrocardiographic findings are nonspecific and include atrioventricular conduction and QRS complex abnormalities and supraventricular and ventricular arrhythmias. Echocardiography and cardiac magnetic resonance (CMR) play a major role in diagnosis. Echocardiography reveals normal or hypertrophied ventricles, preserved systolic function, marked biatrial enlargement, and impaired diastolic function, often with restrictive filling pattern. CMR offering a higher spatial resolution than echocardiography can provide detailed information about anatomic structures, perfusion, ventricular function, and tissue characterization. CMR with late gadolinium enhancement (LGE) and novel approaches (myocardial mapping) can direct the diagnosis to specific subtypes of RCM, depending on the pattern of scar formation. When noninvasive studies have failed, endomyocardial biopsy is required. Differentiation between RCM and constrictive pericarditis (CP), nowadays by echocardiography, is important since both present as heart failure with normal-sized ventricles and preserved ejection fraction but CP can be treated by means of anti-inflammatory and surgical treatment, while the treatment options of RCM are dictated by the underlying condition. Prognosis is generally poor despite optimal medical treatment.
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23
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Ochs MM, Fritz T, Arenja N, Riffel J, Andre F, Mereles D, Siepen FAD, Hegenbart U, Schönland S, Katus HA, Friedrich MGW, Buss SJ. Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis. J Cardiovasc Magn Reson 2017; 19:87. [PMID: 29121956 PMCID: PMC5680757 DOI: 10.1186/s12968-017-0402-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/16/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND To compare the prognostic value of cardiac valve plane displacement (CVPD) on various locations in cardiac light chain (AL) amyloidosis. METHODS Consecutive patients with biopsy-proven cardiac involvement in AL amyloidosis who had undergone cardiovascular magnetic resonance (CMR) between 2005 and 2014 in our institution, were retrospectively identified and data analyzed. The primary combined endpoint was all-cause mortality or heart transplantation. Systolic CVPD were obtained from standard cine bSSFP in 2-, 3- and 4-chamber views at anterior aortic plane systolic excursion (AAPSE); anterior, anterolateral, inferolateral, inferior, inferoseptal mitral (MAPSE); and lateral tricuspid (TAPSE) annular segments. RESULTS We identified 68 patients (58 ± 10 years; 59% male). Median follow-up period was 1.2 years (IQR, 0.3-4.1). Significant differences in CVPD between patients who reached a primary endpoint (n = 44) and transplant-free survivors were found only for AAPSE (6.1 mm (IQR, 4.6-9.4) vs. 8.8 mm (IQR, 6.9-10.4); p = 0.02) and MAPSEanterolateral (7.3 mm (IQR, 5.4-11.7) vs. 10.5 mm (IQR, 8.1-13.4); p = 0.03). AAPSE (χ2 = 15.6; p = 0.0002) provided the best predictive value for transplant-free survival compared to all other valvular plane locations. A high-risk cutoff (AAPSE ≤ 7.6 mm) was calculated by ROC analysis to predict all-cause death or heart transplantation within 6 months from index examination (AUC = 0.80; CI: 0.68 to 0.89; p < 0.0001). AAPSE added incremental prognostic power to an imaging prediction model of late gadolinium enhancement and global longitudinal strain (GLS) (∆χ2 = 5.8, p = 0.02) as well as to a clinical model including Karnofsky index and NT-proBNP (∆χ2 = 6.2, p = 0.01). CONCLUSION In patients with cardiac involvement in AL amyloidosis, systolic CVPD obtained from standard long axis cine views appear to indicate outcome better, when obtained in the anterior aortic plane (AAPSE) and provide incremental prognostic value to LGE and strain measurements.
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Affiliation(s)
- Marco M. Ochs
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Thomas Fritz
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Nisha Arenja
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Florian Andre
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Derliz Mereles
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Fabian aus dem Siepen
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Ute Hegenbart
- Department of Hematooncology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Stefan Schönland
- Department of Hematooncology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | | | - Sebastian J. Buss
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
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24
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Alegría-Landa V, Cerroni L, Kutzner H, Requena L. Paraprotein deposits in the skin. J Am Acad Dermatol 2017; 77:1145-1158. [PMID: 28985955 DOI: 10.1016/j.jaad.2017.07.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/19/2017] [Accepted: 07/23/2017] [Indexed: 02/04/2023]
Abstract
Cutaneous manifestations secondary to paraprotein deposits in the skin include a group of different disorders that although rare, may be the first clinical manifestation of the underlying hematologic dyscrasia. In this article we review the clinical manifestations and histopathologic findings of the processes that result from specific deposition of the paraprotein in different structures of the skin. Paraneoplastic processes frequently associated with hematologic malignancies will not be covered in this review. Some of the disorders included here result from deposition of the intact paraprotein in the skin, whereas in other cases the lesions are due to deposition of modified paraproteins in the form of amyloid substance, cryoglobulins, or crystalglobulins. Cutaneous amyloidoma refers to nodular dermal deposits of amyloid derived from immunoglobulin light chains produced by local plasma cells in the absence of systemic amyloidosis. Dermatologists and dermatopathologists should be aware of the clinical and histopathologic features of these rare disorders because sometimes the cutaneous lesions are the first sign of an underlying silent hematologic malignancy with paraproteinemia.
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Affiliation(s)
| | - Lorenzo Cerroni
- Dermatopathology Research Unit, Medical University of Graz, Graz, Austria
| | - Heinz Kutzner
- Dermatopathologie Friedrichschafen, Friedrichschafen, Germany
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain.
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Delineation of the timing of second-line therapy post–autologous stem cell transplant in patients with AL amyloidosis. Blood 2017; 130:1578-1584. [DOI: 10.1182/blood-2017-05-783415] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/31/2017] [Indexed: 11/20/2022] Open
Abstract
Key Points
Organ progression at second-line therapy predicated inferior survival. Patients relapsing from >VGPR had a longer time to develop organ progression.
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Hammons L, Brazauskas R, Pasquini M, Hamadani M, Hari P, D'Souza A. Presence of fluorescent in situ hybridization abnormalities is associated with plasma cell burden in light chain amyloidosis. Hematol Oncol Stem Cell Ther 2017; 11:105-111. [PMID: 28830801 DOI: 10.1016/j.hemonc.2017.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/06/2017] [Accepted: 07/23/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE/BACKGROUND To assess abnormalities found on CD138-enriched fluorescent in situ hybridization (FISH) studies on pre-treatment bone marrow in systemic amyloid light-chain amyloidosis (AL) and correlate findings between these abnormalities with organ involvement and 1-year survival. METHODS We reviewed 107 patients with systemic AL to identify the impact of a diagnostic FISH study done on plasma cell-enriched bone marrow in our institution between January 2010 and January 2015; 77 had pre-treatment testing performed. RESULTS A total of 77 (61%) patients had abnormal FISH including: hyperdiploidy (29%), t(11;14), (20%), hypodiploidy (16%), t(4;14), (1%), del17p (5%), and+1q21 (5%). Abnormal FISH studies were more likely in those patients with plasma cell involvement≥10% (p=.002). FISH abnormalities were not shown to correlate with stage, cardiac involvement, or survival at 1year. One-year survival was significantly affected by stage at diagnosis and presence of cardiac and hepatic amyloid involvement. CONCLUSION We conclude that in AL, FISH abnormalities are associated with clonal burden. We found no impact of these markers on the type of organ involvement or 1-year survival.
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Affiliation(s)
- Lindsay Hammons
- Medical College of Wisconsin Graduate School, Milwaukee, WI, USA
| | - Ruta Brazauskas
- Division of Biostatistics, Institute of Health and Safety, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcelo Pasquini
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Parameswaran Hari
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Staff NP, Grisold A, Grisold W, Windebank AJ. Chemotherapy-induced peripheral neuropathy: A current review. Ann Neurol 2017; 81:772-781. [PMID: 28486769 PMCID: PMC5656281 DOI: 10.1002/ana.24951] [Citation(s) in RCA: 435] [Impact Index Per Article: 62.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/30/2017] [Accepted: 05/01/2017] [Indexed: 12/16/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting side effect experienced by patients receiving treatment for cancer. Approximately 30 to 40% of patients treated with neurotoxic chemotherapy will develop CIPN, and there is considerable variability in its severity between patients. It is often sensory-predominant with pain and can lead to long-term morbidity in survivors. The prevalence and burden of CIPN late effects will likely increase as cancer survival rates continue to improve. In this review, we discuss the approach to peripheral neuropathy in patients with cancer and address the clinical phenotypes and pathomechanisms of specific neurotoxic chemotherapeutic agents. Ann Neurol 2017;81:772-781.
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Affiliation(s)
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Austria
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental und Clinical
Traumatology, Vienna, Austria
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Chaudhry HM, Mauermann ML, Rajkumar SV. Monoclonal Gammopathy-Associated Peripheral Neuropathy: Diagnosis and Management. Mayo Clin Proc 2017; 92:838-850. [PMID: 28473042 PMCID: PMC5573223 DOI: 10.1016/j.mayocp.2017.02.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 11/25/2022]
Abstract
Monoclonal gammopathies comprise a spectrum of clonal plasma cell disorders that include monoclonal gammopathy of undetermined significance, multiple myeloma, and Waldenström macroglobulinemia. In this review, we outline the epidemiology, etiology, classification, diagnosis, and treatment of monoclonal gammopathy-associated peripheral neuropathy. Monoclonal gammopathy of undetermined significance is relatively common in the general population, with a prevalence of 3% to 4% among individuals older than age 50 years. Therefore, the presence of M protein in a patient with neuropathy does not automatically indicate a causal relationship. Monoclonal gammopathy-associated peripheral neuropathy is often a difficult diagnosis with limited treatment options. Studies addressing the optimal approach to diagnosis and management of this entity are limited. In addition to a review of the literature, we present a diagnostic approach to patients with monoclonal gammopathy-associated peripheral neuropathy and discuss available data and options for treatment.
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Gonzalez-Ramos J, Garrido-Gutiérrez C, González-Silva Y, Yébenes-Gregorio L, Beato- Merino M, Vidaurrázaga-Arcaya C, Herranz-Pinto P. Relapsing bullous amyloidosis of the oral mucosa and acquired cutis laxa in a patient with multiple myeloma: a rare triple association. Clin Exp Dermatol 2017; 42:410-412. [DOI: 10.1111/ced.13084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- J. Gonzalez-Ramos
- Department of Dermatology; Hospital Universitario La Paz; Madrid Spain
| | | | - Y. González-Silva
- Department of Dermatology; Hospital Universitario Infanta Sofia; San Sebastian de los Reyes; Madrid Spain
| | | | - M. Beato- Merino
- Primary Care Medicine; Centro de salud Plaza del Ejercito; Valladolid Spain
| | | | - P. Herranz-Pinto
- Department of Dermatology; Hospital Universitario La Paz; Madrid Spain
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Karafiatova L, Pika T. Amyloid cardiomyopathy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:117-127. [PMID: 28145535 DOI: 10.5507/bp.2017.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/09/2017] [Indexed: 11/23/2022] Open
Abstract
Amyloidosis is a heterogeneous group of diseases characterized by the deposition of amyloid. It is caused by extracellular deposition of insoluble fibrils with beta-pleated sheet configuration. The protein misfolding abnormalities result in amyloid fibrils and may manifest as primary, secondary, or familial amyloidosis. Amyloid deposition can occur in multiple organs (eg, heart, liver, kidney, skin, eyes, lungs, nervous system) resulting in a variety of clinical manifestations. Cardiac involvement can occur as part of a systemic disease or as a localized phenomenon. Cardiac involvement in all types of amyloidosis represents a major negative prognostic factor. Early diagnosis, multi-disciplinary cooperation and proper therapy are key aspects of care for patients with amyloid cardiomyopathy. Early diagnosis is crucial, especially in AL amyloidosis, as patients with advanced heart disease are unsuitable candidates for modern, effective hematological treatment including autologous stem cell transplantation. Despite signal development in diagnostics and therapy, the prognosis for patients with advanced cardiac involvement remains poor. This article is an overview of amyloidosis, providing information about the characteristics of cardiac amyloidosis, and present a structured approach to diagnosis, treatment and prognosis of this condition.
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Affiliation(s)
- Lucie Karafiatova
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Tomas Pika
- Department of Hemato-Oncology, University Hospital Olomouc, Czech Republic
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Abstract
BACKGROUND Amyloidosis is particularly difficult to diagnose because the signs and symptoms are subtle. Additionally, there are no specific imaging or laboratory tests, except histopathology. Although it is considered to be a systemic disorder, a small portion of cases may be localized. INTRODUCTION OF THE CASE A 54-year-old man presented with nonspecific symptoms (jaundice and back pruritus). Biochemical tests showed a high level of bilirubin and elevated serum tumor markers (CA19-9 and CA125). Routine imaging showed hepatomegaly without heterogeneous enhancement. Liver biopsy confirmed the diagnosis of hepatic amyloidosis. No cardiac or renal involvement was found. The patient accepted treatment involving oral chemotherapy. CONCLUSION A rare and unique presentation of hepatic amyloidosis was highlighted in this case.
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Spectrum of manifestations of monoclonal gammopathy-associated renal lesions. Curr Opin Nephrol Hypertens 2016; 25:127-37. [PMID: 26735145 DOI: 10.1097/mnh.0000000000000201] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Monoclonal gammopathies result from an overt malignant process, such as multiple myeloma, or a premalignant process, such as monoclonal gammopathy of undetermined significance. The kidney is often affected in the setting of a monoclonal gammopathy. The term 'monoclonal gammopathy of renal significance (MGRS)' was recently introduced to draw attention to renal diseases related to the monoclonal gammopathy. In this review, we define the pathology of these monoclonal gammopathy-associated kidney diseases. RECENT FINDINGS Renal disease can be caused by deposition of the monoclonal immunoglobulin (direct mechanism) or by activation of the alternative pathway of complement by the monoclonal immunoglobulin (indirect mechanism). The deposition of monoclonal immunoglobulin can affect the glomeruli, tubules, and the interstitium and vessels. The glomerular diseases include proliferative glomerulonephritis with monoclonal immunoglobulin deposits, immunotactoid glomerulopathy, and, less commonly, fibrillary glomerulonephritis. Tubular lesions associated with monoclonal immunoglobulin include cast nephropathy and light-chain proximal tubulopathy. Lesions involving the glomeruli, tubules, interstitium or vessels include amyloidosis and monoclonal immunoglobulin deposition diseases. Rarely, monoclonal immunoglobulin may also cause C3 glomerulopathy or atypical hemolytic uremic syndrome by interfering with the regulation of the alternative pathway of complement. SUMMARY Monoclonal gammopathy are associated with a variety of kidney diseases. The monoclonal gammopathy-associated renal diseases are distinct in their pathogenesis, kidney biopsy findings, clinical presentation, progression, prognosis, and treatment. The term monoclonal gammopathy of renal significance helps highlight patients who have renal disease secondary to monoclonal immunoglobulin secreted by a premalignant or malignant clone, but is not a disease or diagnosis in itself.
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Ochs MM, Riffel J, Kristen AV, Hegenbart U, Schönland S, Hardt SE, Katus HA, Mereles D, Buss SJ. Anterior Aortic Plane Systolic Excursion: A Novel Indicator of Transplant-Free Survival in Systemic Light-Chain Amyloidosis. J Am Soc Echocardiogr 2016; 29:1188-1196. [PMID: 28042785 DOI: 10.1016/j.echo.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anterior aortic plane systolic excursion (AAPSE) was evaluated in the present pilot study as a novel echocardiographic indicator of transplant-free survival in patients with systemic light-chain amyloidosis. METHODS Eighty-nine patients with light-chain amyloidosis were included in the post-hoc analysis. A subgroup of 54 patients with biopsy-proven cardiac amyloid infiltration were compared with 41 healthy individuals to evaluate the discriminative ability of echocardiographic findings. AAPSE is defined as the systolic excursion of the anterior aortic margin. To quantify AAPSE, the M-mode cursor was placed on the aortic valve plane in parasternal long-axis view at end-diastole. Index echocardiography had been performed before chemotherapy. Median follow-up duration was 2.4 years. The primary combined end point was heart transplantation or overall death. RESULTS Mean AAPSE was 14 ± 2 mm in healthy individuals (mean age=57 ± 10 years; 56% men; BMI=25 ± 4 kg/m2). AAPSE < 11 mm separated patients from age-, gender-, and BMI-matched control subjects with 93% sensitivity and 97% specificity. Median transplant-free survival of patients with AAPSE < 5 mm was 0.7 versus 4.8 years (P = .0001). AAPSE was an independent indicator of transplant-free survival in multivariate Cox regression (echocardiographic model: hazard ratio=0.72 [P = .03]; biomarker model: hazard ratio=0.62 [P = .0001]). Sequential regression analysis suggested incremental power of AAPSE as a marker of transplant-free survival. An ejection fraction-based model with an overall χ2 value of 22.8 was improved by the addition of log NT-proBNP (χ2 = 32.6, P < .005), troponin-T (χ2 = 39.6, P < .01), and AAPSE (χ2 = 54.0, P < .0001). CONCLUSIONS AAPSE is suggested as an indicator of transplant-free survival in patients with systemic light-chain amyloidosis. AAPSE provided significant incremental value to established staging models.
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Affiliation(s)
- Marco M Ochs
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
| | - Johannes Riffel
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Ute Hegenbart
- Department of Hematooncology, University of Heidelberg, Heidelberg, Germany
| | - Stefan Schönland
- Department of Hematooncology, University of Heidelberg, Heidelberg, Germany
| | - Stefan E Hardt
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Derliz Mereles
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian J Buss
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
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Hwa YL, Kumar SK, Gertz MA, Lacy MQ, Buadi FK, Kourelis TV, Gonsalves WI, Rajkumar SV, Go RS, Leung N, Kapoor P, Dingli D, Kyle RA, Russell S, lust JA, Hayman SR, Lin Y, Zeldenrust S, Dispenzieri A. Induction therapy pre-autologous stem cell transplantation in immunoglobulin light chain amyloidosis: a retrospective evaluation. Am J Hematol 2016; 91:984-8. [PMID: 27341539 DOI: 10.1002/ajh.24453] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022]
Abstract
There is no consensus on whether patients with immunoglobulin light chain amyloidosis (AL) should receive induction therapy prior to an autologous stem cell transplant (ASCT). This study investigated the relationships between baseline bone marrow plasmacytosis (BMPC), cardiac staging, and pre-transplant induction in AL patients. All patients who received ASCT for AL within 12 months of diagnosis were included. Patient characteristics and outcomes were abstracted. Univariate and multivariate modeling was performed. Among 415 AL patients, 35% had induction prior to ASCT. Post-ASCT hematologic CR plus VGPR rates were significantly higher in those with baseline BMPC ≤ 10% compared to BMPC >10% (58% versus 40%, P = 0.0013). Significant risk factors for lack of attainment of CR included attenuated dose melphalan conditioning, baseline BMPC > 10%, no induction, and male gender. The 5-year OS for the entire group was 65%. On multivariate analysis, risk factors for inferior OS included no induction therapy, advanced AL amyloid staging, BMPC > 10%, attenuated conditioning melphalan dose, and male gender. Patients with Mayo 2012 stage I-II patients with BMPC ≤ 10%, who comprised 56% of the ASCT population fared exceedingly well regardless of whether or not they received induction therapy with a 5-year OS of 81 to 83%. Induction therapy pre-ASCT may improve outcomes among AL patients due to a rapid reduction of toxic light chains or alternatively by elimination of less fit patients by "testing" their ability to tolerate chemotherapy. Prospective studies will be required to sort out these and other questions. Am. J. Hematol. 91:984-988, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yi L. Hwa
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Shaji K. Kumar
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Morie A. Gertz
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Martha Q. Lacy
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | | | | | - Ronald S. Go
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Nelson Leung
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - David Dingli
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Robert A. Kyle
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - John A. lust
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Yi Lin
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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Jelinek T, Kryukova E, Kufova Z, Kryukov F, Hajek R. Proteasome inhibitors in AL amyloidosis: focus on mechanism of action and clinical activity. Hematol Oncol 2016; 35:408-419. [PMID: 27647123 DOI: 10.1002/hon.2351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/11/2022]
Abstract
Proteasome inhibitors are the backbone in the treatment of multiple myeloma with 3 of its representatives (bortezomib, carfilzomib, and ixazomib) having already been approved. There is a different situation altogether in the treatment of amyloid light chain (AL) amyloidosis where owing to the rarity of this entity neither of these drugs has currently gained approval. Amyloid light chain plasma cells are possibly more vulnerable to bortezomib than myeloma plasmocytes because of a slightly distinct mechanism of action, which is described in depth in this manuscript. Bortezomib is highly active and rapidly effective as a single agent and even more potent in combination with dexamethasone and alkylators. Bortezomib-based regimens have become a standard part of the initial treatment of AL amyloidosis in the majority of centers. We have reviewed all available data on bortezomib in various combinations and settings. Carfilzomib seems to be effective but also toxic in these fragile patients with a high rate of cardiac events. Oral ixazomib has shown a surprisingly high efficacy with manageable toxicity and has received the Food and Drug Administration Breakthrough Therapy designation in 2014 for relapsed AL amyloidosis patients. In this review we have comprehensively described the current available knowledge of these 3 proteasome inhibitors and their use in AL amyloidosis.
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Affiliation(s)
- T Jelinek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - E Kryukova
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Z Kufova
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - F Kryukov
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - R Hajek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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[The usage of Mayo staging system in Chinese patients with primary light chain amyloidosis]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:278-82. [PMID: 27093987 PMCID: PMC7343086 DOI: 10.3760/cma.j.issn.0253-2727.2016.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
目的 探讨梅奥分期系统在中国原发性轻链型淀粉样变患者中的临床应用价值。 方法 回顾性分析2009年1月至2015年6月期间在北京协和医院确诊的具有梅奥分期数据的162例原发性轻链型淀粉样变患者的临床资料。 结果 具有完整梅奥2004分期数据的162例患者中,男101例(62.3%),女61例(37.7%),中位年龄57(20~81)岁;Ⅰ、Ⅱ、Ⅲ期患者分别为44例(27.2%)、69例(42.6%)和49例(30.2%),其中位总生存(OS)时间分别为未达到、23个月和12个月,预计2年OS率分别为87.3%、47.4%和29.2%(P<0.001)。具有完整梅奥2012分期数据的128例患者中,1~4期患者分别为48例(37.5%)、32例(25.0%)、32例(25.0%)和16例(12.5%),其中位OS时间分别为未达到、未达到、13个月和3个月,预计2年OS率分别为94.5%、78.6%、25.9%和24.5%(P<0.001)。 结论 梅奥分期系统对于中国原发性轻链型淀粉样变患者具有重要的预后价值。
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Wu X, Feng J, Cao X, Zhang L, Zhou D, Li J. Atypical immunoglobulin light chain amyloidosis: Spontaneous vertebral compression fracture, liver involvement, and bone marrow involvement report of 3 cases and review of the literature. Medicine (Baltimore) 2016; 95:e4603. [PMID: 27603350 PMCID: PMC5023872 DOI: 10.1097/md.0000000000004603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Primary immunoglobulin light chain amyloidosis (AL amyloidosis) is a plasma cell disorder which mainly affects heart, kidneys, liver, and peripheral nervous system. Cases of atypical AL amyloidosis presented as spontaneous vertebral compression fractures have been rarely reported, and data about the management and clinical outcomes of the patients are scarce. METHODS Herein, we present 3 new cases of AL amyloidosis with spontaneous vertebral compression fracture and review 13 cases retrieved from the literature. RESULTS Moreover, we observed overrepresentations of liver involvement and bone marrow involvement in AL amyloidosis with spontaneous vertebral compression fracture. CONCLUSION We believe that better awareness of the rare clinical presentation as spontaneous vertebral compression fracture of AL amyloidosis can facilitate earlier diagnosis and earlier treatment.
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Affiliation(s)
| | | | | | | | | | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
- Correspondence: Jian Li, Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing 100730, PR China (e-mail: )
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Lipsker D. Monoclonal gammopathy of cutaneous significance: review of a relevant concept. J Eur Acad Dermatol Venereol 2016; 31:45-52. [PMID: 27501129 DOI: 10.1111/jdv.13847] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022]
Abstract
Some dermatologic entities are strongly associated with the presence of a monoclonal gammopathy. They should be referred to as monoclonal gammopathy of cutaneous significance (MGCS). A short review of the main entities that fit into the spectrum of MGCS is provided. Amyloidosis, macroglobulinoderma and follicular hyperkeratotic spicules result from extravascular immunoglobulin or immunoglobulin-related protein deposition. Skin findings include papules and plaques, follicular spicules, purpura, haemorrhagic bullae, macroglossia and nail changes. The skin findings in cryoglobulinemia (CG) result from vascular immunoglobulin deposition, either as immune complexes within the vessel walls in mixed CG or within the lumina of small vessels in monoclonal CG. Mixed CG manifests as palpable purpura of leukocytoclastic vasculitis, and monoclonal CG as stellar and/or retiform purpura that can evolve into extensive skin necrosis. In some rare instances, immunoglobulins have a specific biological activity. This is, for example, the case when they bind lipoproteins that precipitate and induce hypocomplementemic xanthomas. Xanthoderma related to antiflavin activity of the monoclonal component or acquired angioedema related to anti-C1INH activity is other example. Abnormal cytokine secretion is the hallmark of some entities. High vascular endothelial growth factor levels correlate with some of the skin manifestations of the Polyneuropathy organomegaly endocrinopathy monoclonal component skin changes syndrome, such as hypertrichosis or the adenopathy and extensive skin patch overlying plasmacytoma syndrome. All the clinical manifestations of the Schnitzler syndrome are IL-1 mediated. In other MGCS, such as scleromyxedema, Clarkson syndrome, TEMPI syndrome, cutis laxa and the neutrophilic dermatoses, the link between the monoclocal component and the entity is clearly established, but not understood so far.
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Affiliation(s)
- D Lipsker
- Faculté de Médecine, Université de Strasbourg et Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Guinault D, Canet E, Huart A, Jaccard A, Ribes D, Lavayssiere L, Venot M, Cointault O, Roussel M, Nogier MB, Pichereau C, Lemiale V, Arnulf B, Attal M, Chauveau D, Azoulay E, Faguer S. Short- and long-term outcomes of AL amyloidosis patients admitted into intensive care units. Br J Haematol 2016; 174:868-75. [PMID: 27292694 DOI: 10.1111/bjh.14135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/02/2016] [Indexed: 11/27/2022]
Abstract
Amyloidosis is a rare and threatening condition that may require intensive care because of amyloid deposit-related organ dysfunction or therapy-related adverse events. Although new multiple myeloma drugs have dramatically improved outcomes in AL amyloidosis, the outcomes of AL patients admitted into intensive care units (ICUs) remain largely unknown. Admission has been often restricted to patients with low Mayo Clinic staging and/or with a complete or very good immunological response at admission. In a retrospective multicentre cohort of 66 adult AL (n = 52) or AA (n = 14) amyloidosis patients, with similar causes of admission to an ICU, the 28-d and 6-month survival rates of AA patients were significantly higher compared to AL patients (93% vs. 60%, P = 0·03; 71% vs. 45%, P = 0·02, respectively). In AL patients, the simplified Index of Gravity Score (IGS2) was the only independent predictive factor for death by day 28, whereas the Mayo-Clinic classification stage had no influence. In Cox's multivariate regression model, only cardiac arrest and on-going chemotherapy at ICU admission significantly predicted death at 6 months. Short-term outcomes of AL patients admitted into an ICU were mainly related to the severity of the acute medical condition, whereas on-going chemotherapy for active amyloidosis impacted on long-term outcomes.
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Affiliation(s)
- Damien Guinault
- Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, CHU de Toulouse, Toulouse, France
| | - Emmanuel Canet
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Antoine Huart
- Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, CHU de Toulouse, Toulouse, France
| | - Arnaud Jaccard
- Service d'Hématologie, Centre de référence des amyloses AL, Hôpital Dupuytren, Limoges, France
| | - David Ribes
- Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, CHU de Toulouse, Toulouse, France
| | - Laurence Lavayssiere
- Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, CHU de Toulouse, Toulouse, France
| | - Marion Venot
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Olivier Cointault
- Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, CHU de Toulouse, Toulouse, France
| | - Murielle Roussel
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse, Oncopôle, Toulouse, France
| | - Marie-Béatrice Nogier
- Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, CHU de Toulouse, Toulouse, France
| | - Claire Pichereau
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Virginie Lemiale
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Bertrand Arnulf
- Service d'Hématologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Michel Attal
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse, Oncopôle, Toulouse, France.,Université Toulouse III, Toulouse, France
| | - Dominique Chauveau
- Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, CHU de Toulouse, Toulouse, France.,Université Toulouse III, Toulouse, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut des maladies cardiovasculaires et métaboliques, Toulouse, France
| | - Elie Azoulay
- Service d'Hématologie, Centre de référence des amyloses AL, Hôpital Dupuytren, Limoges, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, CHU de Toulouse, Toulouse, France.,Université Toulouse III, Toulouse, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut des maladies cardiovasculaires et métaboliques, Toulouse, France
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Grisold W, Grisold A, Löscher WN. Neuromuscular complications in cancer. J Neurol Sci 2016; 367:184-202. [PMID: 27423586 DOI: 10.1016/j.jns.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/08/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
Cancer is becoming a treatable and even often curable disease. The neuromuscular system can be affected by direct tumor invasion or metastasis, neuroendocrine, metabolic, dysimmune/inflammatory, infections and toxic as well as paraneoplastic conditions. Due to the nature of cancer treatment, which frequently is based on a DNA damaging mechanism, treatment related toxic side effects are frequent and the correct identification of the causative mechanism is necessary to initiate the proper treatment. The peripheral nervous system is conventionally divided into nerve roots, the proximal nerves and plexus, the peripheral nerves (mono- and polyneuropathies), the site of neuromuscular transmission and muscle. This review is based on the anatomic distribution of the peripheral nervous system, divided into cranial nerves (CN), motor neuron (MND), nerve roots, plexus, peripheral nerve, the neuromuscular junction and muscle. The various etiologies of neuromuscular complications - neoplastic, surgical and mechanic, toxic, metabolic, endocrine, and paraneoplastic/immune - are discussed separately for each part of the peripheral nervous system.
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Affiliation(s)
- W Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.
| | - A Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - W N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Bhutani M, Shahid Z, Schnebelen A, Alapat D, Usmani SZ. Cutaneous manifestations of multiple myeloma and other plasma cell proliferative disorders. Semin Oncol 2016; 43:395-400. [DOI: 10.1053/j.seminoncol.2016.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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43
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Gadiwalla Y, Burnham R, Warfield A, Praveen P. Surgical management of macroglossia secondary to amyloidosis. BMJ Case Rep 2016; 2016:10.1136/bcr-2015-214078. [PMID: 27068724 DOI: 10.1136/bcr-2015-214078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors report a case of amyloidosis-induced macroglossia treated with surgical reduction of the tongue using a keyhole to inverted T method with particular emphasis on the postoperative sequelae. Significant tongue swelling persisted for longer than anticipated requiring tracheostomy to remain in situ for 14 days.
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Affiliation(s)
- Yusuf Gadiwalla
- Department of Oral & Maxillofacial Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Burnham
- Department of Oral & Maxillofacial Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Adrian Warfield
- Department of Oral & Maxillofacial Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Prav Praveen
- Department of Oral & Maxillofacial Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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[Autologous peripheral blood hematopoietic stem cell transplantation for patients with primary light chain amyloidosis: experience of 31 cases in a single center]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:201-4. [PMID: 27033756 PMCID: PMC7342947 DOI: 10.3760/cma.j.issn.0253-2727.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 探讨自体外周血造血干细胞移植(ASCT)治疗原发性轻链型淀粉样变性的疗效和安全性。 方法 回顾性分析2009年1月至2015年6月接受ASCT治疗的31例原发性轻链型淀粉样变性患者的临床资料、疗效、生存及转归。 结果 31例患者中男18例、女13例,中位年龄55(43~66)岁;20例患者为单器官受累;80.6%的患者为Mayo 1期;诊断至ASCT的中位时间为3(0.5~26)个月;粒细胞植入和血小板植入的中位时间分别为11(9~12) d和11(8~14) d;无移植相关死亡病例。在可评价疗效的27例患者中,总体血液学缓解率为85.2%(23例),其中完全缓解率和非常好的部分缓解率分别为63.0%(17例)和7.4%(2例),获得最佳血液学缓解的中位时间为4(1~21)个月。总体器官缓解率为59.2%,获得器官缓解的中位时间为8(3~18)个月。中位随访21个月,1例患者死亡,3例患者出现疾病进展,预计的3年无进展生存率和总生存率分别为92.8%和96.4%。 结论 ASCT对于早期原发性轻链型淀粉样变性患者是一种有效、安全的治疗手段。
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Zhao Q, Wang L, Song P, Li F, Zhou X, Yu Y, An Z, Wang X, Zhai Y. [Comparison analysis of outcomes in primary light chain amyloidosis patients treated by auto peripheral blood stem cell transplantation or bortezomib plus dexamethasone]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:283-7. [PMID: 27093989 PMCID: PMC7343081 DOI: 10.3760/cma.j.issn.0253-2727.2016.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore the feature of primary light chain amyloidosis patients treated with high-dose melphalan with auto peripheral blood stem cell transplantation (auto-PBSCT) and bortezomib plus dexamethasone (VD). METHODS Thirty-eight patients diagnosed from September 2004 to September 2012 were analyzed retrospectively, including 15 cases received auto-PBSCT, 23 cases exposed with VD. RESULTS The median follow-up duration for the patients was 34 months (range, 1-112 months), including auto-PBSCT group of 38 months (range, 5-112 months) and VD group of 31 months (range, 1-108 months). The organ response rate in all the patients was 39.5% (15/38), and the organ response rate between these two groups has no significant difference [33.3% (5/15) vs 43.5% (10/23), P=0.532]. However, the median time of organ response was significant difference [6 (3-10) months vs 3 (1-6) months, respectively (P=0.032)]. The 3-year overall survival (OS) rates in the two groups were 72.0% and 66.9%, and their average survival were 84.7 months and 75.9 months, respectively (P=0.683). In the patients with auto-PBSCT, the occurrence of III-IV grade of bone marrow suppression (P<0.001), fever (P<0.001), nausea and infection (P=0.006) were obviously higher than those with VD, but there was no statistically significant difference in pulmonary infection (P=0.069) and bloodstream infection (P=0.059). CONCLUSIONS The preliminary results have presented that primary light chain amyloidosis patients treated with auto-PBSCT or VD had similar organ response rate and survival. However, more adverse events occurred in the group of auto-PBSCT.
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Affiliation(s)
- Qian Zhao
- Department of Hematology, Jinling Hospital, Nanjing 210002, China
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Serum free light chain assays not total light chain assays are the standard of care to assess Monoclonal Gammopathies. Rev Bras Hematol Hemoter 2016; 38:37-43. [PMID: 26969773 PMCID: PMC4786779 DOI: 10.1016/j.bjhh.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 11/12/2015] [Accepted: 11/18/2015] [Indexed: 11/22/2022] Open
Abstract
The diagnosis of Multiple Myeloma is a challenge to the physician due to the non-specific symptoms (anemia, bone pain and recurrent infections) that are commonplace in the elderly population. However, early diagnosis is associated with less severe disease, including fewer patients presenting with acute renal injury, pathological fractures and severe anemia. Since 2006, the serum free light chain test Freelite(®) has been included alongside standard laboratory tests (serum and urine protein electrophoresis, and serum and urine immunofixation) as an aid in the identification of monoclonal proteins, which are a cornerstone for the diagnosis of Multiple Myeloma. The serum free light chain assay recognizes the light chain component of the immunoglobulin in its free form with high sensitivity. Other assays that measure light chains in the free and intact immunoglobulin forms are sensitive, but unfortunately, due to the nomenclature used, these assays (total light chains) are sometimes used in place of the free light chain assay. This paper reviews the available literature comparing the two assays and tries to clarify hypothetical limitations of the total assay to detect Multiple Myeloma. Furthermore, we elaborate on our study comparing the two assays used in 11 Light Chain Multiple Myeloma patients at presentation and 103 patients taken through the course of their disease. The aim of this article is to provide a clear discrimination between the two assays and to provide information to physicians and laboratory technicians so that they can utilize the International Myeloma Working Group guidelines.
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47
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Comparative evaluation of p5+14 with SAP and peptide p5 by dual-energy SPECT imaging of mice with AA amyloidosis. Sci Rep 2016; 6:22695. [PMID: 26936002 PMCID: PMC4776142 DOI: 10.1038/srep22695] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/22/2016] [Indexed: 11/08/2022] Open
Abstract
Amyloidosis is a protein-misfolding disorder characterized by the extracellular deposition of amyloid, a complex matrix composed of protein fibrils, hyper-sulphated glycosaminoglycans and serum amyloid P component (SAP). Accumulation of amyloid in visceral organs results in the destruction of tissue architecture leading to organ dysfunction and failure. Early differential diagnosis and disease monitoring are critical for improving patient outcomes; thus, whole body amyloid imaging would be beneficial in this regard. Non-invasive molecular imaging of systemic amyloid is performed in Europe by using iodine-123-labelled SAP; however, this tracer is not available in the US. Therefore, we evaluated synthetic, poly-basic peptides, designated p5 and p5+14, as alternative radiotracers for detecting systemic amyloidosis. Herein, we perform a comparative effectiveness evaluation of radiolabelled peptide p5+14 with p5 and SAP, in amyloid-laden mice, using dual-energy SPECT imaging and tissue biodistribution measurements. All three radiotracers selectively bound amyloid in vivo; however, p5+14 was significantly more effective as compared to p5 in certain organs. Moreover, SAP bound principally to hepatosplenic amyloid, whereas p5+14 was broadly distributed in numerous amyloid-laden anatomic sites, including the spleen, liver, pancreas, intestines and heart. These data support clinical validation of p5+14 as an amyloid radiotracer for patients in the US.
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48
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Fozza C, Corda G, Barraqueddu F, Virdis P, Contini S, Isoni A, Dore F, Podda L, Longinotti M. Evidence of a skewed T-cell repertoire in patients with light chain amyloidosis. Hematol Oncol 2016; 36:492-494. [PMID: 26857096 DOI: 10.1002/hon.2281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/15/2015] [Accepted: 12/22/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Claudio Fozza
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giovanna Corda
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Patrizia Virdis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Contini
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Antonella Isoni
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Fausto Dore
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Luigi Podda
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Ueno A, Katoh N, Aramaki O, Makuuchi M, Ikeda SI. Liver Transplantation Is a Potential Treatment Option for Systemic Light Chain Amyloidosis Patients with Dominant Hepatic Involvement: A Case Report and Analytical Review of the Literature. Intern Med 2016; 55:1585-90. [PMID: 27301510 DOI: 10.2169/internalmedicine.55.6675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Systemic light chain (AL) amyloidosis is caused by abnormal plasma cell clones producing amyloidogenic light chains. The standard treatment is therefore chemotherapy targeting these clones, however, some patients are ineligible due to liver dysfunction. For these patients, preceding liver transplantation (LT) and following chemotherapy is a possible treatment option. We herein report a 58-year-old man with advanced hepatic AL amyloidosis who was successfully treated using this strategy. Previously reported cases treated with LT for this condition were reviewed, however, the outcomes were not favorable. We additionally investigated potential prognostic factors of this treatment approach to improve the outcome of these patients.
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Affiliation(s)
- Akihiro Ueno
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
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Hsiao PJ, Chiang WF, Chao TK, Lin SH. Life-threatening hematuria in a hemodialysis patient with systemic light-chain amyloidosis. Clin Chim Acta 2015; 451:180-2. [PMID: 26434538 DOI: 10.1016/j.cca.2015.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Direct amyloid invasion of prostate tissue resulting in massive bleeding may be fatal, and rapid diagnosis is difficult. CASE REPORT A 71-y-old male undergoing regular hemodialysis with primary light-chain (AL) amyloidosis was admitted due to gross hematuria for 2 days. Cystoscopy revealed oozing from the prostatic urethra. Therefore, electrocauterization was performed, and his symptoms resolved. Unfortunately, he experienced recurrent massive hematuria 3 months later. Tests for serum D-dimer and fibrin degradation products were both positive. Followed serum factor X level was low at 5.4%. Gross hematuria persisted despite of blood transfusions, desmopressin, and vitamin K therapy. Emergent cystoscopy revealed oozing from the prostatic urethra, as was found previously. Therefore, electrocauterization and transurethral resection of the prostate were performed. Analysis of a biopsy specimen of prostate demonstrated strong amyloid deposition in the vascular and perivascular regions. Electron microscopy showed relatively straight fibrils with diameters of 7-10nm in the perivascular region. Gross hematuria subsided then, and no recurrence was noted at a 6-month follow-up. CONCLUSIONS Systemic AL amyloidosis can cause potentially life-threatening hemorrhage. Hemostatic defects and direct invasion with amyloid angiopathy are main pathogenic factors. Timely surgical intervention may be imperative.
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Affiliation(s)
- Po-Jen Hsiao
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Wen-Fang Chiang
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Tai-Kuang Chao
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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