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Souza LVS, Souza AS, Marchiori E. Tracheobronchial amyloidosis and multiple myeloma. J Bras Pneumol 2024; 50:e20240080. [PMID: 38808833 PMCID: PMC11185130 DOI: 10.36416/1806-3756/e20240080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Affiliation(s)
| | - Arthur Soares Souza
- . Ultra X, São José do Rio Preto (SP) Brasil
- . Faculdade de Medicina de Rio Preto, São José do Rio Preto (SP) Brasil
| | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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2
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Jimenez‐Zepeda VH, Reece D, Rigo R, Gogna P, Kong S, Hu XY, Chapani P, Cheung WY, Brenner DR, Plante R, Shi K, Husain A, Tankala D, Boyne DJ. Understanding real-world treatment patterns and clinical outcomes in AL amyloidosis patients diagnosed in Canada: A population-based cohort study. EJHAEM 2022; 3:1262-1269. [PMID: 36467790 PMCID: PMC9713227 DOI: 10.1002/jha2.562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 06/17/2023]
Abstract
Amyloid light chain (AL) amyloidosis is a rare and chronic bone marrow disorder. Existing claims data can be used to help understand the real-world treatment patterns and outcomes of this patient population. Various population-based administrative databases in Alberta, Canada were queried from 2010 to mid-2019 to identify cases of AL amyloidosis. Baseline patient and disease characteristics, sequencing of pharmacologic therapies, overall survival, and healthcare resource utilization were evaluated. A total of 215 individuals with AL amyloidosis were included. Among patients diagnosed between 2012 and 2019, 149 (85.1%) initiated first-line, 67 (38.3%) initiated second-line, 22 (12.6%) initiated third-line, and 11 (6.3%) initiated fourth-line systemic therapy. In the first-line setting, 99/149 (66.4%) received bortezomib, cyclophosphamide, and dexamethasone (CyBorD) and 21/149 (14.1%) received another bortezomib-based regimen. Survival from time of diagnosis improved over time, with a median overall survival of 25.8 months (95% CI: 9.8, 57.1) for individuals diagnosed in 2010-2011 versus 52.1 months (95% CI: 25.6, NA) for those diagnosed in 2012-2019. Despite this improvement, the proportion of individuals diagnosed in 2012-2019 who survived beyond five-years remained low (5-year survival: 48.4%; 95% CI: 40.9, 57.2) which highlights an unmet need for more efficacious therapies.
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Affiliation(s)
| | - Donna Reece
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Rodrigo Rigo
- Oncology Outcomes Research InitiativeUniversity of CalgaryCalgaryAlbertaCanada
- Department of Oncology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Priyanka Gogna
- Oncology Outcomes Research InitiativeUniversity of CalgaryCalgaryAlbertaCanada
- Department of Public Health SciencesQueen's UniversityKingstonOntarioCanada
| | - Shiying Kong
- Oncology Outcomes Research InitiativeUniversity of CalgaryCalgaryAlbertaCanada
- Department of Oncology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health ScienceUniversity of CalgaryCalgaryAlbertaCanada
| | - Xun Yang Hu
- Oncology Outcomes Research InitiativeUniversity of CalgaryCalgaryAlbertaCanada
- Department of Oncology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Parv Chapani
- Oncology Outcomes Research InitiativeUniversity of CalgaryCalgaryAlbertaCanada
- Department of Oncology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Winson Y. Cheung
- Oncology Outcomes Research InitiativeUniversity of CalgaryCalgaryAlbertaCanada
- Department of Oncology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Darren R. Brenner
- Oncology Outcomes Research InitiativeUniversity of CalgaryCalgaryAlbertaCanada
- Department of Oncology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health ScienceUniversity of CalgaryCalgaryAlbertaCanada
| | - Richard Plante
- Department of Medical Affairs, JanssenTorontoOntarioCanada
| | - Kun Shi
- Department of Market Access, JanssenTorontoOntarioCanada
| | - Asad Husain
- Department of Market Access, JanssenTorontoOntarioCanada
| | - Dipti Tankala
- Department of Market Access, JanssenTorontoOntarioCanada
| | - Devon J. Boyne
- Oncology Outcomes Research InitiativeUniversity of CalgaryCalgaryAlbertaCanada
- Department of Oncology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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3
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Qatanani A, Dahab S, Douedi S, Hamid Y, Girgis S, Daniels S, Lamba G, Zafar M. Delayed Diagnosis of Cardiac Amyloidosis Secondary to Multiple Myeloma. J Med Cases 2021; 12:391-394. [PMID: 34691334 PMCID: PMC8510665 DOI: 10.14740/jmc3744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/14/2021] [Indexed: 11/13/2022] Open
Abstract
Cardiac amyloidosis is a rare condition with only 2,500 new cases reported yearly in the United States of America (USA). The prognosis of cardiac amyloidosis is particularly grim. The median survival is 6 months from onset of congestive heart failure (CHF) symptoms. CHF is a common presentation as the second leading cause of hospitalization in the senile population in the USA. We report a case of an 83-year-old man who presented with the classic symptoms of CHF including bilateral lower extremity edema, shortness of breath, and weight gain. Upon further workup, an echocardiogram revealed strain patterns suggestive of cardiac amyloidosis and bone marrow biopsy confirmed the diagnosis of multiple myeloma. Unfortunately, despite starting treatment with steroids and chemotherapy, the patient succumbed to his condition in a matter of weeks. We report this case to highlight that cardiac amyloidosis secondary to multiple myeloma can present in the form of new onset, quickly deteriorating CHF long before any classic multiple myeloma symptoms manifest.
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Affiliation(s)
- Ahmad Qatanani
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Shereen Dahab
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Yumna Hamid
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Sameh Girgis
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Steven Daniels
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Gurpreet Lamba
- Department of Hematology & Oncology, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Mohammad Zafar
- Department of Nephrology, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
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4
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Suggestive Diagnostic Process in a Case of Multiple Myeloma with Gastrointestinal Immunoglobulin Light-Chain Amyloidosis Accompanied by Protein-Losing Enteropathy. Case Rep Gastrointest Med 2021; 2021:5533993. [PMID: 34136288 PMCID: PMC8177977 DOI: 10.1155/2021/5533993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/22/2021] [Indexed: 11/18/2022] Open
Abstract
Multiple myeloma is a type of plasma cell neoplasm that produces monoclonal immunoglobulin. Multiple myeloma is known to cause immunoglobulin light-chain (AL) amyloidosis, which frequently involves the kidney and heart. Bone pain or fractures caused by osteolytic lesions and physical disorders related to renal or cardiac AL amyloidosis are major initial symptoms in multiple myeloma. Multiple myeloma diagnosed from the gastrointestinal symptoms is rare. We report a case of an 80-year-old man with multiple myeloma accompanied by gastrointestinal AL amyloidosis and secondary protein-losing enteropathy. The diagnostic process was suggestive, in that diarrhea and refractory leg edema related to protein-losing enteropathy were the primary symptoms and the trigger for making a sequential diagnosis of gastrointestinal AL amyloidosis and underlying multiple myeloma. This case is highly suggestive, in that multiple myeloma with gastrointestinal AL amyloidosis should be considered one of the background diseases of protein-losing enteropathy.
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Clinical Presentation, Renal Histopathological Findings, and Outcome in Patients with Monoclonal Gammopathy and Kidney Disease. Int J Nephrol 2021; 2021:8859340. [PMID: 34094600 PMCID: PMC8137312 DOI: 10.1155/2021/8859340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 11/21/2022] Open
Abstract
Monoclonal gammopathies are associated with acute and chronic kidney injury. Nephrotoxicity of the secreted monoclonal (M)-protein is related to its biological properties and blood concentration. Little is known about epidemiology, clinical manifestations, and outcome of monoclonal gammopathies in patients with kidney disease. We retrospectively collected data about demographics, clinical manifestations, and renal histological lesions of all patients (n = 1334) who underwent kidney biopsy between January 2000 and March 2017. Monoclonal gammopathy was detected in 174 (13%) patients with a mean age of 66.4 ± 13.1 years. The spectrum of monoclonal gammopathies comprised monoclonal gammopathy of undetermined significate (MGUS) (52.8%), multiple myeloma (MM) (25.2%), primary amyloidosis (AL) (9.1%), smoldering MM (SMM) (4%), non-Hodgkin lymphoma (NHL) (6.8%), and Hodgkin lymphoma (HL) (1.7%). Monoclonal gammopathy of renal significance (MGRS) accounted for 6.5% in patients with MGUS and 14.2% in patients with SMM. Evaluation of kidney biopsy revealed that M-protein was directly involved in causing kidney injury in MM (93.1%). MM was the only gammopathy significantly associated with an increased risk of kidney injury (odds ratio [OR] = 47.5, CI 95%, 13.7–164.9; P ≤ 0.001). While there were no significant differences in the progression toward end-stage renal disease or dialysis (P = 0.776), monoclonal gammopathies were associated with a different risk of death (P = 0.047) at the end of the follow-up. In conclusion, monoclonal gammopathy was a frequent finding (13%) in patients who underwent kidney biopsy. M-protein was secreted by both premalignant (56.8%) and malignant (43.2%) lymphoproliferative clones. Kidney biopsy had a key role in identifying MGRS in patients with MGUS (6.5%) and SMM (14.2%). Among monoclonal gammopathies, only MM was significantly associated with biopsy-proven kidney injury. The rate of end-stage renal disease or dialysis was similar among monoclonal gammopathies, whereas NHL, MM, and SMM showed a higher rate of deaths.
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Lee SKY, Muller O, Rasmussen C. Prosthetic Rehabilitation with Amyloidosis of the Tongue. J Prosthodont 2020; 29:725-729. [PMID: 32794594 DOI: 10.1111/jopr.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 11/27/2022] Open
Abstract
Amyloidosis of the tongue can result in significant and irreversible alterations of tooth position and function due to prolonged application of imbalanced force on the teeth by the enlarged tongue. Due to the rarity of this oral form of systemic disease, little has been elucidated on management of the resulting impaired oral function. While surgery can address the size of the tongue, it carries significant morbidities, enlargement can recur, and does not address adverse tooth positioning. Prosthetic rehabilitation can more aptly restore oral function but it also needs to be tailored based on the patient's expectations and goals as well as biologic and mechanical parameters of treatment. This report discusses an effective and noninvasive application of a tooth-supported, removable prosthesis with an onlay occlusal design to restore occlusion, speech, and esthetics in a patient with tongue-based amyloidosis.
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Affiliation(s)
- Sarah Kay Youny Lee
- Department of Dental Specialties, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905
| | - Olivia Muller
- Department of Dental Specialties, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905
| | - Chad Rasmussen
- Department of Dental Specialties, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905
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7
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Zayas-Santiago A, Díaz-García A, Nuñez-Rodríguez R, Inyushin M. Accumulation of amyloid beta in human glioblastomas. Clin Exp Immunol 2020; 202:325-334. [PMID: 32654112 PMCID: PMC7670151 DOI: 10.1111/cei.13493] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
Many cancer types are intrinsically associated with specific types of amyloidosis, in which amyloid is accumulated locally inside tumors or systemically. Usually, this condition relates to the hyperproduction of specific amylogenic proteins. Recently, we found that the accumulation of amyloid beta (Aβ) peptide immunofluorescence is linked to glioma cells in mouse tumors. Here we report that amyloid-specific histochemical dyes reveal amyloid accumulation in all human glioma samples. Application of two different antibodies against Aβ peptide (a polyclonal antibody against human Aβ1-42 and a monoclonal pan-specific mAb-2 antibody against Aβ) showed that the amyloid in glioma samples contains Aβ. Amyloid was linked to glioma cells expressing glial-specific fibrillary acidic protein (GFAP) and to glioma blood vessels. Astrocytes close to the glioma site and to affected vessels also accumulated Aβ. We discuss whether amyloid is produced by glioma cells or is the result of systemic production of Aβ in response to glioma development due to an innate immunity reaction. We conclude that amyloid build-up in glioma tumors is a part of the tumor environment, and may be used as a target for developing a novel class of anti-tumor drugs and as an antigen for glioma visualization.
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Affiliation(s)
- A Zayas-Santiago
- Physiology Department, Medical School, Universidad Central del Caribe, Bayamon, Puerto Rico
| | - A Díaz-García
- Physiology Department, Medical School, Universidad Central del Caribe, Bayamon, Puerto Rico
| | - R Nuñez-Rodríguez
- Biochemistry Department, Medical School, Universidad Central del Caribe, Bayamon, Puerto Rico
| | - M Inyushin
- Physiology Department, Medical School, Universidad Central del Caribe, Bayamon, Puerto Rico
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Kogler W, Canha C, Makary R, Omman R, Isache CL. Multiple myeloma with extensive AL amyloidosis presenting as chronic diarrhoea. BMJ Case Rep 2020; 13:13/1/e232934. [PMID: 31919068 DOI: 10.1136/bcr-2019-232934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We present a 52-year-old man admitted to the hospital with diarrhoea and lower extremity weakness ongoing for the past 3 months. The patient was found to have malabsorptive diarrhoea, hypoproliferative anaemia and renal insufficiency with proteinuria. Extensive workup was performed including a bone marrow biopsy with 20% plasma cells, renal and duodenal biopsies with Congo-red staining revealed amyloid deposition. The patient was diagnosed with multiple myeloma and amyloidosis with gastrointestinal, kidney and nerve involvement explaining his presentation with diarrhoea, renal insufficiency and weakness. Throughout his admission, there were incidental findings of asymptomatic hypoglycaemia (serum blood glucose <40 mg/dL), which was later found to be caused by anti-insulin monoclonal antibodies produced by the neoplastic plasma cells. This is an extremely rare manifestation of multiple myeloma with only a few cases reported in the literature.
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Affiliation(s)
- William Kogler
- Internal Medicine, UF Health Jacksonville, Jacksonville, Florida, USA
| | - Catarina Canha
- Internal Medicine, UF Health Jacksonville, Jacksonville, Florida, USA
| | - Raafat Makary
- Pathology, University of Florida Health Science Center Jacksonville, Jacksonville, Florida, USA
| | - Reeba Omman
- Pathology, University of Florida Health Science Center Jacksonville, Jacksonville, Florida, USA
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Patil P, Panarelli NC. Educational Case: Ischemic Disorders of the Gut in Adult Patients. Acad Pathol 2019; 6:2374289519888709. [PMID: 31799383 PMCID: PMC6873276 DOI: 10.1177/2374289519888709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/02/2019] [Accepted: 10/13/2019] [Indexed: 12/14/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040. 1.
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Affiliation(s)
- Priyanka Patil
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole C Panarelli
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
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Palumbo E, Zhao B, Xue B, Uversky VN, Davé V. Analyzing aggregation propensities of clinically relevant PTEN mutants: a new culprit in pathogenesis of cancer and other PTENopathies. J Biomol Struct Dyn 2019; 38:2253-2266. [PMID: 31232187 DOI: 10.1080/07391102.2019.1630005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
While studies on pathological protein aggregation are largely limited to neurodegenerative disease, emerging evidence suggests that other diseases are also associated with pathogenic protein aggregation. For example, tumor suppressor protein p53, and its mutant conformers, undergo protein aggregation, exacerbating the cancer phenotype. These findings raise the possibility that inactivation of tumor suppressors via protein aggregation may participate in cancer and other disease pathologies. Since tumor suppressor protein PTEN has similar functions to p53, and is mutated in multiple diseases, we examined the aggregation propensity of PTEN wild-type and 1523 clinically relevant PTEN mutants. Applying computational tools to PTEN mutation databases revealed that PTEN wild-type protein can aggregate under physiological conditions, and 274 distinct PTEN mutants had increased aggregation propensity. To understand the mechanism underlying PTEN conformer aggregation, we analyzed the physicochemical properties of these 274 PTEN mutants and defined their aggregation potential. We conclude that increased aggregation propensity of select PTEN mutants may contribute to disease phenotypes. Our studies have built the foundation for interrogating the aggregation potential of these select mutants in cancers and in PTENopathies. Elucidating the pathogenic mechanisms associated with aggregation-prone PTEN conformers will aid in developing therapies that target PTEN-aggregates in multiple diseases.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Emily Palumbo
- Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Bi Zhao
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, FL, USA
| | - Bin Xue
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, FL, USA
| | - Vladimir N Uversky
- Department of Molecular Medicine, Morsani College of Medicine, Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA.,Institute for Biological Instrumentation of the Russian Academy of Sciences, Pushchino, Moscow Region, Russia
| | - Vrushank Davé
- Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Suspected Pericardial Tuberculosis Revealed as an Amyloid Pericardial Mass. Case Rep Hematol 2018; 2018:8606430. [PMID: 30416832 PMCID: PMC6207883 DOI: 10.1155/2018/8606430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/05/2018] [Accepted: 09/12/2018] [Indexed: 12/30/2022] Open
Abstract
Primary systemic amyloidosis is not easily diagnosed. The immunoglobulin deposits are usually localized in the kidney, heart, and liver. We describe an unusual case of a patient suffering from a pericardial amyloidoma with internal calcifications and air bubbles that compressed the right ventricle and shifted the heart to the left. Since the patient was in shock, urgent pericardiotomy was performed. This site showed PET uptake. A monoclonal component was present. On these findings, differential diagnoses included multiple myeloma and atypical pericardial tuberculosis, whereas a periumbilical fat tissue biopsy demonstrated amyloidosis. A previous Salmonella species infection had most likely stimulated the production of amyloid. The patient received bortezomib/dexamethasone treatment and achieved a good response.
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12
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Abstract
In amyloidosis, there is an extracellular deposition of beta-sheet fibrils. Over 25 proteins have been demonstrated to form amyloid. One of them is Ig amyloid light (AL) chains. We are presenting a 40-year-old female who presented with progressive kyphoscoliosis for last 2 years following a minor trauma and bilateral pedal edema for last 3 months. On further investigation, we found that she had a biclonal variety of MM with amyloidosis of kidney leading to massive proteinuria. Very few case reports are available where patient with biclonal variety of MM develop renal amyloidosis.
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Affiliation(s)
- A Hajra
- Department of Internal Medicine, IPGMER, Kolkata, West Bengal, India
| | - D Bandyopadhyay
- Department of Accident and Emergency, Lady Hardinge Medical College, New Delhi, India
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Zhang J, Shao C, Zhu J, Tu C, Lv X. Abdominal distension and diarrhea as the main symptoms of primary amyloidosis: A case report and literature review. Exp Ther Med 2016; 11:1809-1811. [PMID: 27168808 DOI: 10.3892/etm.2016.3093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/29/2015] [Indexed: 11/06/2022] Open
Abstract
Amyloidosis is a systemic disease caused by the accumulation of extracellular protein into amyloid deposits. Due to the involvement of a variety of organs and tissues, the disease has no specific clinical features and a high rate of misdiagnosis. The present study describes one case of primary amyloidosis, as confirmed by biopsies of rectal and renal tissues using Congo red staining, demonstrating that abdominal distension and diarrhea were the main symptoms of disease. The current case is also discussed within the context of a review of the associated literature.
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Affiliation(s)
- Jian Zhang
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Chuxiao Shao
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Jinde Zhu
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Chaoyong Tu
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Xinliang Lv
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
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Weisel KC, Dimopoulos MA, Moreau P, Lacy MQ, Song KW, Delforge M, Karlin L, Goldschmidt H, Banos A, Oriol A, Alegre A, Chen C, Cavo M, Garderet L, Ivanova V, Martinez-Lopez J, Knop S, Yu X, Hong K, Sternas L, Jacques C, Zaki MH, San Miguel J. Analysis of renal impairment in MM-003, a phase III study of pomalidomide + low - dose dexamethasone versus high - dose dexamethasone in refractory or relapsed and refractory multiple myeloma. Haematologica 2016; 101:872-8. [PMID: 27081177 DOI: 10.3324/haematol.2015.137083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/12/2016] [Indexed: 01/28/2023] Open
Abstract
Pomalidomide + low-dose dexamethasone is effective and well tolerated for refractory or relapsed and refractory multiple myeloma after bortezomib and lenalidomide failure. The phase III trial MM-003 compared pomalidomide + low-dose dexamethasone with high-dose dexamethasone. This subanalysis grouped patients by baseline creatinine clearance ≥ 30 - < 60 mL/min (n=93, pomalidomide + low-dose dexamethasone; n=56, high-dose dexamethasone) or ≥ 60 mL/min (n=205, pomalidomide + low-dose dexamethasone; n=93, high-dose dexamethasone). Median progression-free survival was similar for both subgroups and favored pomalidomide + low-dose dexamethasone versus high-dose dexamethasone: 4.0 versus 1.9 months in the group with baseline creatinine clearance ≥ 30 - < 60 mL/min (P<0.001) and 4.0 versus 2.0 months in the group with baseline creatinine clearance ≥ 60 mL/min (P<0.001). Median overall survival for pomalidomide + low-dose dexamethasone versus high-dose dexamethasone was 10.4 versus 4.9 months (P=0.030) and 15.5 versus 9.2 months (P=0.133), respectively. Improved renal function, defined as an increase in creatinine clearance from < 60 to ≥ 60 mL/min, was similar in pomalidomide + low-dose dexamethasone and high-dose dexamethasone patients (42% and 47%, respectively). Improvement in progression-free and overall survival in these patients was comparable with that in patients without renal impairment. There was no increase in discontinuations of therapy, dose modifications, and adverse events in patients with moderate renal impairment. Pomalidomide at a starting dose of 4 mg + low-dose dexamethasone is well tolerated in patients with refractory or relapsed and refractory multiple myeloma, and of comparable efficacy if moderate renal impairment is present. This trial was registered with clinicaltrials.gov identifier 01311687 and EudraCT identifier 2010-019820-30.
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Affiliation(s)
- Katja C Weisel
- Hematology and Oncology, Department of Medicine, University Hospital Tübingen, Germany
| | | | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Michel Delforge
- Department of Hematology, University Hospitals Leuven, Belgium
| | - Lionel Karlin
- Centre Hospitalier Lyon Sud/Hospices Civils de Lyon, Pierre-Bénite, France
| | | | - Anne Banos
- Hematology, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Albert Oriol
- Institut Catala d'Oncologia, Hospital Germans Trias I Pujol, Barcelona, Spain
| | | | | | - Michele Cavo
- Bologna University School of Medicine, Institute of Hematology and Medical Oncology, Bologna, Italy
| | | | | | | | - Stefan Knop
- Hematology and Oncology, Würzburg University Medical Center, Würzburg, Germany
| | - Xin Yu
- Celgene Corporation, Summit, NJ, USA
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Clinicopathological features of renal amyloidosis: a single-center study on 47 cases. ACTA ACUST UNITED AC 2015; 35:48-53. [PMID: 25673192 DOI: 10.1007/s11596-015-1387-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/25/2014] [Indexed: 10/24/2022]
Abstract
The correlations between the clinicopathological features and the long-term outcomes of renal amyloidosis (RA) were analyzed with a view to develop strategies for improving diagnosis and prognosis of RA. We retrospectively reviewed the clinicopathological characteristics of 47 patients diagnosed with RA between 2004 and 2014 at the Wuhan Union Hospital. The data on the renal histology, clinical manifestations, and prognosis of RA patients were retrieved from the hospital records and characteristic patterns were identified. The histological changes in the kidneys were correlated with the clinical manifestations of RA. Additionally, most RA patients in this study had decreased serum levels of κ light chain and increased urine levels of κ and λ light chains as well as presence of M-protein in the urine and serum. Patients with early RA showed no specific pathognomonic symptoms. Bleeding associated with diagnostic renal biopsy was rare. We recommend that the routine work-up of patients aged over 40 years and presenting with non-diabetic nephropathy includes the non-invasive tests for the measurement of serum and urine levels of κ and λ light chains as well as protein electrophoresis tests for the presence of urinary and serum M-protein. Additionally, such patients should undergo renal biopsy screening with Cong-red staining to ensure early diagnosis of RA and improve their survival, since the risk of hemorrhage related to renal biopsy screening is low at early stages of RA.
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Bladder perforation secondary to primary systemic amyloidosis. Case Rep Urol 2014; 2014:123795. [PMID: 25587481 PMCID: PMC4283257 DOI: 10.1155/2014/123795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/11/2014] [Indexed: 11/17/2022] Open
Abstract
Amyloidosis is a disorder of protein folding characterized by extracellular aggregation and deposition of amyloid protein fibrils. Light-chain amyloidosis, also known as primary systemic amyloidosis, is the most common form of the disease. We present a case of an 84-year-old male with a history of systemic primary amyloidosis causing genitourinary, cardiac, and autonomic dysfunction who presented with hematuria and hypotension secondary to bladder perforation. He underwent open repair of a large extraperitoneal bladder defect. He ultimately died as a result of medical complications from his disease.
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Reece DE, Hegenbart U, Sanchorawala V, Merlini G, Palladini G, Bladé J, Fermand JP, Hassoun H, Heffner L, Kukreti V, Vescio RA, Pei L, Enny C, Esseltine DL, van de Velde H, Cakana A, Comenzo RL. Long-term follow-up from a phase 1/2 study of single-agent bortezomib in relapsed systemic AL amyloidosis. Blood 2014; 124:2498-506. [PMID: 25202139 PMCID: PMC4199951 DOI: 10.1182/blood-2014-04-568329] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/11/2014] [Indexed: 01/26/2023] Open
Abstract
CAN2007 was a phase 1/2 study of once- and twice-weekly single-agent bortezomib in relapsed primary systemic amyloid light chain amyloidosis (AL) amyloidosis. Seventy patients were treated, including 18 and 34 patients at the maximum planned doses on the once- and twice-weekly schedules. This prespecified final analysis provides mature response and long-term outcomes data after 3-year additional follow-up since the last report. In the once-weekly 1.6 mg/m(2) and twice-weekly 1.3 mg/m(2) bortezomib groups, final hematologic response rates were 68.8% and 66.7%; 80% of patients in each group sustained their response for ≥1 year. One-year progression-free rates were 72.2% and 76.8%. Median overall survival (OS) was 62.1 months and not reached; 4-year OS rates were 75.0% and 63.0%. Low baseline difference in κ/λ free light-chain level was associated with higher hematologic complete response rates and longer OS. At data cutoff, 40 (57%) patients had received subsequent therapy, including 19 (27%) retreated with bortezomib, 11 (58%) of whom achieved complete or partial hematologic responses. Four patients received prolonged bortezomib for between 3.5 and 5.6 years, with no new safety concerns, highlighting the feasibility of long-term therapy. Single-agent bortezomib produced durable hematologic responses and promising long-term OS in relapsed AL amyloidosis. This trial was registered at www.clinicaltrials.gov as #NCT00298766.
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Affiliation(s)
- Donna E Reece
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Ute Hegenbart
- Amyloidosis Center, University of Heidelberg, Heidelberg, Germany
| | | | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Joan Bladé
- Hematology Department, Institute of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Hani Hassoun
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Leonard Heffner
- Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | | | | | - Lixia Pei
- Janssen Research and Development, LLC, Raritan, NJ
| | | | | | - Helgi van de Velde
- Janssen Research and Development, Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Andrew Cakana
- Janssen Research and Development, High Wycombe, United Kingdom; and
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