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Meng X, He J, Cheng F, Yan H, Zhu C, Guo X, Li Y, Cai Z, He D. Successful Treatment of Systemic Light Chain Amyloidosis with Liver Involvement using Low-Frequency Daratumumab: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942534. [PMID: 38229422 PMCID: PMC10806375 DOI: 10.12659/ajcr.942534] [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: 09/13/2023] [Revised: 12/15/2023] [Accepted: 11/25/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Systemic light chain (AL) amyloidosis is a disease characterized by the deposition of amyloid fibrils throughout tissues due to the production of misfolded immunoglobulin light chains by clonally expanded populations of CD38+ plasma cells. Some patients can have liver involvement, which typically presents with nonspecific symptoms. Daratumumab, a human CD38-targeting antibody, has shown efficacy in improving hematological parameters and organ function in patients with AL amyloidosis. Low-frequency daratumumab can reduce financial burden, but whether it is effective for patients with liver involvement has not been reported. CASE REPORT We present the case of a 64-year-old man admitted to our hospital with fatigue and recurrent fever. Histological analysis of a liver biopsy demonstrated AL amyloidosis. Bone marrow biopsy demonstrated the presence of abnormal plasma cells. Laboratory test results demonstrated increased levels of circulating free kappa (kappa) light chains, which were also seen on blood and urine immunofixation electrophoresis. Based on these findings, AL amyloidosis of the kappa light chain type with liver, cardiac, and renal involvement was diagnosed. The patient ultimately achieved hematological stringent complete response, liver remission, renal complete response, and cardiac very good partial response after 2 cycles of the low-frequency daratumumab, bortezomib, and dexamethasone regimen and 4 cycles of daratumumab and dexamethasone regimen chemotherapy. CONCLUSIONS The case indicates that low-frequency daratumumab treatment can have efficacy in AL amyloidosis with liver involvement.
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Affiliation(s)
- Xinyi Meng
- Department of Hematology, Bone Marrow Transplantation Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Jingsong He
- Department of Hematology, Bone Marrow Transplantation Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Fei Cheng
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Hui Yan
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Chunting Zhu
- Department of Hematology, Bone Marrow Transplantation Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Xing Guo
- Department of Hematology, Bone Marrow Transplantation Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Yi Li
- Department of Hematology, Bone Marrow Transplantation Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Zhen Cai
- Department of Hematology, Bone Marrow Transplantation Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Donghua He
- Department of Hematology, Bone Marrow Transplantation Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
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Dias E, Cardoso H, Marques M, Liberal R, Lopes S, Pereira P, Santos-Antunes J, Pinheiro J, Lopes J, Carneiro F, Macedo G. Hepatic amyloidosis: a prevalence study and clinical characterization of a rare and severe disease. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:16-21. [PMID: 35297258 DOI: 10.17235/reed.2022.8622/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIM Amyloidosis is a systemic disease characterized by extracellular deposition of amyloid protein, most commonly in the heart and kidney. Hepatic amyloidosis is a rare form of presentation that ranges from mild hepatomegaly and altered liver biochemical tests to acute liver failure. The aims of this study were to evaluate the prevalence of amyloidosis in patients undergoing liver biopsy and describe its main clinical characteristics and prognostic impact. METHODS A retrospective analysis of all patients with a histological diagnosis of hepatic amyloidosis between January 2010 and December 2019 was performed. MAJOR RESULTS A total of 7 patients were identified from a total of 1773 liver biopsy procedures (0.4%), with a female predominance (6/7) and median age of diagnosis of 62 years. The most common clinical manifestations included hepatomegaly (4/7), jaundice (2/7) and peripheral edema (2/7), whereas 3/7 patients were asymptomatic. Every patient presented abnormalities in liver biochemical tests, more commonly cholestasis (6/7), but also cytolysis (4/7) or hyperbilirubinemia (2/7). Abnormal imaging findings included hepatomegaly, steatosis or parenchymal heterogeneity. In most patients (5/7), other organs were involved, most commonly with nephrotic syndrome (3/7) and infiltrative cardiomyopathy (3/7). The most common type was AA amyloidosis (3/7) followed by AL amyloidosis (2/7). The 1-year mortality rate was 43% and the median survival was 24 months. CONCLUSIONS We report a low prevalence (0.4%) of amyloidosis among patients undergoing liver biopsy. Although rare, hepatic amyloidosis is associated with a dismal prognosis and a high index of suspicion is crucial to achieve an early diagnosis. .
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Affiliation(s)
- Emanuel Dias
- Gastrenterology , Centro Hospitalar Universitário de São João, Portugal
| | - Hélder Cardoso
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Margarida Marques
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Rodrigo Liberal
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Susana Lopes
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Pedro Pereira
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
| | | | | | - Joanne Lopes
- Pathology, Centro Hospitalar Universitário de São João
| | | | - Guilherme Macedo
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
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Amyloidosis: A Rare Cause of Severe Cholestasis and Acute Liver Failure. ACG Case Rep J 2021; 7:e00479. [PMID: 34604435 PMCID: PMC8483873 DOI: 10.14309/crj.0000000000000479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022] Open
Abstract
Although hepatic involvement in light chain–associated amyloidosis is common, clinical manifestations of hepatic amyloidosis are rare. In most cases, hepatomegaly serves as a clue to diagnosis. We report a unique case of a 48-year-old man from China with jaundice and noncirrhotic portal hypertension, with rapidly progressive liver failure, in the absence of hepatomegaly, secondary to systemic light chain–associated amyloidosis associated with multiple myeloma.
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Hepatocyte Growth Factor and Primary Systemic Amyloidosis. J UOEH 2021; 43:227-233. [PMID: 34092767 DOI: 10.7888/juoeh.43.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 75-year-old-man experienced liver dysfunction and was diagnosed with decompensated liver cirrhosis. His serum hepatocyte growth factor (HGF) was very high (16.24 ng/ml). Because the etiology was unclear, we considered the possibility of amyloidosis. Biopsy of the mucosa of the stomach, duodenum and rectum demonstrated amyloid deposition. From the findings of Congo red staining and immunohistochemical analyses, we made a diagnosis of systemic amyloid light-chain amyloidosis. Unfortunately, the patient died one month after the diagnosis. We considered that serum HGF was useful for the diagnosis and prediction of prognosis of primary systemic amyloidosis.
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Taha ZI, Adam Essa ME, Idris Abdelhalim AT, Elamin Elnour MAA, Osman Eltayeb AA, Mohammed Elwakeel SAA, Abdallah Ahmed A. A Male Case of Renal Amyloidosis. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2020; 000:1-5. [DOI: 10.14218/jerp.2020.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Muhammad Khan M, Ur Rashid M, Ullah W, Hussain I, Hurairah A. Rare case of acute on chronic hepatic failure in a patient with multiple myeloma-associated amyloidosis. BMJ Case Rep 2020; 13:13/1/e231563. [PMID: 31996385 DOI: 10.1136/bcr-2019-231563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Amyloidosis is the extracellular deposition of unique protein fibrils in different tissue organs. It is most commonly associated with B-cell malignancy such as multiple myeloma or Waldenstrom macroglobulinaemia. It involves the liver, heart, kidney, peripheral nerves and soft tissues. Liver however is affected, but clinically apparent disease is very rare. Hepatomegaly and mild elevation of alkaline phosphatase is the most common presentation in patients with liver involvement. Acute hepatic failure is a rare presentation with myeloma-induced amyloidosis. The diagnosis can be difficult requiring biopsy or sometimes special staining of the tissue. Management is still very challenging.
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Affiliation(s)
| | - Mamoon Ur Rashid
- Internal Medicine, AdventHealth Dade City, Dade City, Florida, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Ishtiaq Hussain
- Internal Medicine, Mardan Medical Complex, Mardan, Khyber Pakhtunkhwa, Pakistan
| | - Abu Hurairah
- Internal Medicine, AdventHealth Dade City, Dade City, Florida, USA
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Riveiro-Barciela M, Gironella M, Senín A, Salcedo MT, Merino-Casabiel X, Castells L, Esteban R, Buti M, Martínez-Valle F. Decompensated Liver Disease due to Primary Hepatic Amyloidosis: Is Liver Transplantation Still Mandatory? Hepatology 2019; 69:2701-2703. [PMID: 30561765 DOI: 10.1002/hep.30464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/11/2018] [Indexed: 12/07/2022]
Affiliation(s)
- Mar Riveiro-Barciela
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Merche Gironella
- Department of Hematology, Hematology, Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
| | - Alicia Senín
- Department of Hematology, Hematology, Vall d'Hebron Institut d'Oncologia, Barcelona, Spain.,Department of Hematology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | | | - Xavier Merino-Casabiel
- Abdominal Imaging Unit, Radiology Department, Hospital Universitario Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluis Castells
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Esteban
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Buti
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Martínez-Valle
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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