1
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Collet A, Attias P, Lacou M, Fieschi C, Moktefi A, Sannier A, Grateau G, Buob D, Georgin-Lavialle S. AA-type amyloidosis associated with lymphoma: a study of 19 cases including 5 new French cases and a systematic literature review. Leuk Lymphoma 2023; 64:1857-1863. [PMID: 37493601 DOI: 10.1080/10428194.2023.2239971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Aurore Collet
- Sorbonne Université, GRC 28 SU, AP-HP, Hôpital Tenon, Service de médecine interne, Centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), Paris, France
| | - Philippe Attias
- Hôpital privé Nord Parisien, Service de néphrologie, Paris, France
| | - Mathieu Lacou
- CHU de Nantes, service de médecine interne, Nantes, France
| | - Claire Fieschi
- Clinical Immunology Department, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris (APHP) Université Paris Diderot, Paris, France
| | - Anissa Moktefi
- APHP (Assistance Publique-Hôpitaux de Paris), Département de Pathologie, Hôpitaux Universitaires Henri Mondor, Univ Paris Est Créteil, Créteil, France
| | - Aurélie Sannier
- Département de Pathologie, Université de Paris, INSERM U1148, Hôpital Bichat, Paris, France
| | - Gilles Grateau
- Sorbonne Université, GRC 28 SU, AP-HP, Hôpital Tenon, Service de médecine interne, Centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), Paris, France
| | - David Buob
- AP-HP, Hôpital Tenon, Anatomie et cytologie pathologiques, Paris, France
| | - Sophie Georgin-Lavialle
- Sorbonne Université, GRC 28 SU, AP-HP, Hôpital Tenon, Service de médecine interne, Centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), Paris, France
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2
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Pang Y, Li D, Chen Y, Liu Q, Wu Y, Teng Q, Liu Y. Thymus and lung mucosa-associated lymphoid tissue lymphoma with adenocarcinoma of the lung: a case report and literature review. World J Surg Oncol 2023; 21:20. [PMID: 36691049 PMCID: PMC9869556 DOI: 10.1186/s12957-023-02904-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/26/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Mucosa-associated lymphoid tissue (MALT) lymphoma is a common, low-grade, malignant B-cell lymphoma. However, simultaneous MALT lymphoma in the thymus and lung is extremely rare, and concomitant adenocarcinoma of the lung is even rarer. Herein, we report a rare case of a collision tumor in which MALT lymphoma was found in both the thymus and lung with Sjögren's syndrome (SS) and adenocarcinoma in the lung. CASE PRESENTATION A physical examination of a 32-year-old woman revealed an anterior superior mediastinal space-occupying lesion, and chest computed tomography (CT) indicated a nodular ground-glass opacity and irregular mixed-density focus in the right lung. All lung cancer-related tumor biomarkers were within normal ranges. The thymus and part of the lung tissue were surgically resected. The histopathology and molecular examinations confirmed MALT lymphoma of the thymus and lung with lung adenocarcinoma. SS was also diagnosed. No special postoperative treatment was performed for the MALT lymphoma, and the patient underwent immunosuppressive therapy for SS after 4 months of follow-up observation. CONCLUSIONS MALT lymphoma of the thymus and lung tissues has no specific presentation on imaging and is difficult to differentiate from common malignant tumors, and the definite diagnoses of these tumors are highly dependent on histopathological examination in combination with molecular testing and cytogenetics. SS may be an important potential condition for the occurrence of MALT lymphoma in the thymus and lung. Additional similar cases are needed to clarify the biological pathways and potential molecular mechanisms of rare lymphomas and collision tumors.
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Affiliation(s)
- Yu Pang
- grid.410645.20000 0001 0455 0905Department of Pathology, the Affiliated Taian City Central Hospital of Qingdao University, Tai’an, 271000 China
| | - Daosheng Li
- grid.410645.20000 0001 0455 0905Department of Pathology, the Affiliated Taian City Central Hospital of Qingdao University, Tai’an, 271000 China
| | - Yiqian Chen
- grid.410645.20000 0001 0455 0905Department of Rehabilitation, the Affiliated Taian City Central Hospital of Qingdao University, Tai’an, 271000 China
| | - Qinqin Liu
- grid.410645.20000 0001 0455 0905Department of Hematology, the Affiliated Taian City Central Hospital of Qingdao University, Tai’an, 271000 China
| | - Yuheng Wu
- grid.410645.20000 0001 0455 0905Department of Medical Imaging, the Affiliated Taian City Central Hospital of Qingdao University, Tai’an, 271000 China
| | - Qingliang Teng
- grid.410645.20000 0001 0455 0905Department of Hematology, the Affiliated Taian City Central Hospital of Qingdao University, Tai’an, 271000 China
| | - Yuyu Liu
- grid.410645.20000 0001 0455 0905Department of Hematology, the Affiliated Taian City Central Hospital of Qingdao University, Tai’an, 271000 China
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3
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Shah K, Kollimuttathuillam SV, Bethel N, Shaaban H. Peritumoral Immunoglobulin M Lambda Light Chain Amyloidosis in a Patient With Advanced Follicular Lymphoma. Cureus 2022; 14:e21738. [PMID: 35251810 PMCID: PMC8887873 DOI: 10.7759/cureus.21738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/15/2022] Open
Abstract
Peritumoral light chain (AL) amyloidosis secondary to lymphoid malignancies is a rare but well-described entity. Peritumoral deposition of amyloid without systemic amyloidosis has been described in mucosa-associated lymphoid tissue (MALT) lymphomas; however, there are no reported cases of follicular lymphoma with localized peritumoral AL amyloidosis without systemic involvement of amyloidosis. We present a rare case of a patient with advanced follicular lymphoma with peritumoral lymph node IgM lambda light chain amyloidosis without an underlying monoclonal gammopathy or plasma cell dyscrasia.
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4
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la Torre AD, Reece D, Crump M, Atenafu EG, Chen C, Prica A, Kukreti V. Light Chain Amyloidosis (AL) Associated With B Cell Lymphoma a Single Center Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e946-e959. [PMID: 34384733 DOI: 10.1016/j.clml.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Light chain (AL) amyloidosis and B-cell lymphoma represent 5% to 7% of all AL, Systemic amyloidosis, deposits in sites remote from the underlying lymphoma, and peritumoral amyloidosis deposition is within the immediate vicinity. MATERIALS AND METHODS We conducted a retrospectively study to identify and describe AL with B cell lymphoma at Princess Margaret Cancer Center from 01 January 1997 to 31 July 2019. RESULTS Thirty-five patients with AL and lymphoma, an incidence of 6, 2%, median age of diagnosis of 66 (range 47 to 86), majority male, most had underlying Waldestrom's Macroglobulinemia. 21 patients with peritumoral AL (PAL), and 15 with systemic AL. 42.8% of the patients had major organ involvement. 35% got treatment with Rituximab with alkylator, 20% received proteasome inhibitors, 17% patients were on a watch and wait approach, amyloid response showed very good partial response > 45.8%, and lymphoma ORR was 42.8%, with a median follow up of 31.5 months. A 36 month overall survival (OS) and progression-free survival (PFS) showed worse outcomes for heart involvement OS (P = .002), PFS (0.057) and IgM subtype OS (P = .02), PFS (0.01). CONCLUSION We have shown adverse outcome with IgM AL and to document a differences in OS and PFS not previously reported for PAL.
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Affiliation(s)
- Alfredo De la Torre
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Ontario, Canada.
| | - Donna Reece
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Ontario, Canada
| | - Michael Crump
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Center, Ontario, Canada
| | - Christine Chen
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Ontario, Canada
| | - Anca Prica
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Ontario, Canada
| | - Vishal Kukreti
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Ontario, Canada
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5
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Adachi Y, Takimoto T, Takeda M, Matsumoto K, Takeuchi N, Kagawa T, Sakamoto T, Kasai T, Sugimoto C, Inoue Y, Tachibana K, Arai T, Inoue Y. Lymphoplasmacytic lymphoma involving the mediastinum and the lung, followed by amyloidosis: A surgically and genetically proven case. Respir Med Case Rep 2020; 31:101313. [PMID: 33318921 PMCID: PMC7723813 DOI: 10.1016/j.rmcr.2020.101313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022] Open
Abstract
A 60-year-old man was admitted for ground glass opacity in the lower lung field and mediastinal lymphadenopathy. Blood tests revealed elevated serum IgM levels, and the urine test detected Bence-Jones protein. Surgical biopsy from the mediastinal lymph node and lung showed small lymphocytes and plasma cells between follicles, and AL kappa amyloid deposition. Genetic examination detected MYD88 L265P mutation. Our diagnosis was lymphoplasmacytic lymphoma (LPL), involving the mediastinum and the lung, followed by amyloidosis. Mutation analysis, in addition to conventional histological evaluation, was useful for a precise diagnosis.
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Affiliation(s)
- Yuichi Adachi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Takayuki Takimoto
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Maiko Takeda
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Kinnosuke Matsumoto
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Naoko Takeuchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Tomoko Kagawa
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Tetsuki Sakamoto
- Department of Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Takahiko Kasai
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Chikatoshi Sugimoto
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Yasushi Inoue
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Kazunobu Tachibana
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan.,Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Toru Arai
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
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6
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Godara A, Palladini G. Monoclonal Antibody Therapies in Systemic Light-Chain Amyloidosis. Hematol Oncol Clin North Am 2020; 34:1145-1159. [PMID: 33099430 DOI: 10.1016/j.hoc.2020.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In systemic light-chain amyloidosis, monoclonal antibodies target antigens that are either membrane-bound or circulating or deposited in the organs. CD38 holds high promise as a target against clonal plasma cells. Multiple anti-CD38 antibodies are either approved for use or being investigated in clinical trials. Daratumumab has been investigated and has clinical efficacy in upfront or refractory settings. High rates of hematologic response are seen with daratumumab, which translates to high organ response rates. Rituximab is usually integrated into the treatment regimen for IgM amyloidosis. Anti-amyloid therapies have shown preclinical proof of principle, but lack confirmation of improvement.
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Affiliation(s)
- Amandeep Godara
- Divsion of Hematology-Oncology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Giovanni Palladini
- Department of Molecular Medicine, Amyloidosis Research and Treatment Center Foundations, "Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo", University of Pavia, Viale Golgi, 19 IT, Pavia 27100, Italy.
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7
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Bianchi G, Kumar S. Systemic Amyloidosis Due to Clonal Plasma Cell Diseases. Hematol Oncol Clin North Am 2020; 34:1009-1026. [PMID: 33099420 DOI: 10.1016/j.hoc.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Immunoglobulin light chain amyloidosis is the most common systemic amyloidosis. The pathogenetic mechanism is deposition of fibrils of misfolded immunoglobulin free light chains, more often lambda, typically produced by clonal plasma cells. Distinct Ig light chain variable region genotypes underlie most light chain amyloidosis and dictate tissue tropism. Light chain amyloidosis fibrils cause distortion of the histologic architecture and direct cytotoxicity, leading to rapidly progressive organ dysfunction and eventually patient demise. A high index of clinical suspicion with rapid tissue diagnosis and commencement of combinatorial, highly effective cytoreductive therapy is crucial to avoid irreversible organ damage and early mortality.
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Affiliation(s)
- Giada Bianchi
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Shaji Kumar
- Myeloma, Amyloidosis, Dysproteinemia Group, Mayo Clinic, First Street Southwest, Rochester, MN 55904, USA.
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8
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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: 11] [Impact Index Per Article: 2.8] [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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9
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You S, Sun JS, Park KJ, Koh YW. Amyloid deposition in thymic extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in a patient with myasthenia gravis: A case report. Thorac Cancer 2020; 11:781-784. [PMID: 31943837 PMCID: PMC7049503 DOI: 10.1111/1759-7714.13294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022] Open
Abstract
Extranodal marginal zone lymphoma of mucosa‐associated lymphoid tissue (MALT) in the thymus is a rare disease. Furthermore, amyloid deposition in thymic MALT lymphoma has not been previously described. Here, we report a case of a 35‐year‐old man with thymic MALT lymphoma with amyloid deposition and myasthenia gravis. Chest computed tomography revealed an anterior mediastinal mass with internal cystic component and extensive calcification. Total thymectomy was performed and histopathologic findings were compatible with a diffuse amyloid deposition in extranodal marginal zone MALT lymphoma. The results indicate that thymic MALT lymphoma should be considered as a possible diagnosis in patients with a solid and cystic thymic mass and autoimmune disease, including myasthenia gravis.
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Affiliation(s)
- Seulgi You
- Department of Radiology, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Republic of Korea
| | - Joo S Sun
- Department of Radiology, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Republic of Korea
| | - Kyung J Park
- Department of Radiology, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Republic of Korea
| | - Young W Koh
- Department of Pathology, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Republic of Korea
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10
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Matsumoto Y, Masuda T, Nishimura A, Horie H, Harada K, Yoshida M, Shimura K, Kaneko H, Taniwaki M. A case of AL amyloidosis associated with follicular lymphoma with plasmacytic differentiation. Int J Hematol 2019; 111:317-323. [DOI: 10.1007/s12185-019-02734-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 12/15/2022]
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11
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Shaulov A, Prus D, Lavie D, Elias S. Duodenal amyloid A depositions in a patient with refractory Hodgkin's lymphoma: an old complication in the modern treatment era. Amyloid 2018; 25:263-264. [PMID: 30350721 DOI: 10.1080/13506129.2018.1517737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Adir Shaulov
- a Department of Hematology , Hadassah - Hebrew University Medical Center , Jerusalem , Israel
| | - Diana Prus
- b Department of Pathology , Hadassah - Hebrew University Medical Center , Jerusalem , Israel
| | - David Lavie
- c Department of Hematology , Hadassah - Hebrew University Medical Center , POB 91120 , Jerusalem 12000 , Israel
| | - Shlomo Elias
- c Department of Hematology , Hadassah - Hebrew University Medical Center , POB 91120 , Jerusalem 12000 , Israel
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12
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Lisenko K, Schönland SO, Jauch A, Andrulis M, Röcken C, Ho AD, Goldschmidt H, Hegenbart U, Hundemer M. Flow cytometry-based characterization of underlying clonal B and plasma cells in patients with light chain amyloidosis. Cancer Med 2016; 5:1464-72. [PMID: 27109862 PMCID: PMC4944872 DOI: 10.1002/cam4.725] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/05/2016] [Accepted: 03/07/2016] [Indexed: 11/15/2022] Open
Abstract
Systemic amyloid light chain (AL) amyloidosis is a life‐threatening protein deposition disorder; however, effective therapy can dramatically improve the prognosis of AL patients. Therefore, accurate diagnosis of the underlying hematologic disease is important. Multi‐parameter flow cytometry (MFC) is a reliable method to analyze lymphatic neoplasias and to detect even a small lymphatic clone. We analyzed the presence of clonal plasma cell (PC) and B cells in the bone marrow of 63 patients with newly diagnosed AL amyloidosis by MFC. We compared the results with the levels of monoclonal protein, the histopathology and cytogenetic results. As reference of light chain restriction, we used the immunohistochemical results of κ or λ positive amyloid deposits in various tissues. MFC identified underlying clonal lymphatic cells in all but two patients (61 of 63, 97%). Sixty‐one patients harbored malignant PCs, whereas B‐cell lymphomas were identified in two patients. Furthermore, MFC indicated at least one putative immunotherapeutical target (CD20, CD38, CD52, or SLAMF7) on malignant PCs in all but one patient. These results demonstrate that MFC is a reliable tool for an accurate diagnosis of the underlying hematologic disease and the detection of potential immunotherapeutical targets in patients with AL amyloidosis.
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Affiliation(s)
- Katharina Lisenko
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Stefan O Schönland
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Anna Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | | | - Christoph Röcken
- Department of Pathology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Anthony D Ho
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Ute Hegenbart
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Michael Hundemer
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
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13
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Dubrey SW, Patel K, Lachmann H, Sugai T, Cook T, Hill P. Non-Hodgkin's lymphoma causing light-chain (AL) amyloidosis. Br J Hosp Med (Lond) 2016; 77:188-9. [PMID: 26961452 DOI: 10.12968/hmed.2016.77.3.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Simon W Dubrey
- Consultant in Cardiology in the Department of Cardiology, Hillingdon and Mount Vernon Hospitals NHS Trust, Uxbridge, Middlesex UB8 3NN
| | - Ketan Patel
- Consultant in Haematology in the Department of Haematology, Hillingdon and Mount Vernon Hospitals NHS Trust, Uxbridge, Middlesex
| | - Helen Lachmann
- Reader and Honorary Consultant in Renal Medicine in the National Amyloid Centre, UCL Division of Medicine, Royal Free Campus, London
| | - Taku Sugai
- Consultant in Haematology in the Department of Haematology, Hillingdon and Mount Vernon Hospitals NHS Trust, Uxbridge, Middlesex
| | - Terry Cook
- Professor in Histopathology in the Department of Histopathology, Hammersmith Hospital, London
| | - Peter Hill
- Consultant in Renal Medicine in the Department of Renal Medicine, Hammersmith Hospital, London
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14
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Mehta N, Schöder H, Chiu A, Schoolmeester JK, Portlock C. Adnexal mass secondary to extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) with associated amyloid deposition. BMJ Case Rep 2014; 2014:bcr-2014-206699. [PMID: 25398916 DOI: 10.1136/bcr-2014-206699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Systemic amyloid light chain amyloidosis (AL amyloidosis) is usually seen in association with a plasma cell disorder. Amyloid deposition associated with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is a rare phenomenon that is not typically associated with systemic AL amyloidosis. We describe the unusual case of a patient with an adnexal mass secondary to MALT lymphoma with associated amyloid deposition.
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Affiliation(s)
- Neha Mehta
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - April Chiu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Carol Portlock
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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15
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von Keudell G, Sanchorawala V, O'Hara C, C Seldin D, Sloan JM. Simultaneous presentation of kappa-restricted chronic lymphocytic leukemia and lambda light chain AL amyloidosis. Amyloid 2014; 21:124-7. [PMID: 24471777 DOI: 10.3109/13506129.2013.854205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report on a 58-year-old man who presented with simultaneous kappa-restricted chronic lymphocytic leukemia (CLL) and a lambda-restricted plasma cell dyscrasia causing AL amyloidosis involving the kidney and GI tract. While monoclonal immunoglobulins occasionally produced by CLL has previously been implicated in AL amyloidosis, this is the first case of AL amyloidosis resulting from a distinct plasma cell dyscrasia that is not clonally related to the concurrent CLL. Appropriate treatment depended on detailed pathologic diagnosis of both disease processes.
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16
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Hemminki K, Li X, Försti A, Sundquist J, Sundquist K. Cancer risk in amyloidosis patients in Sweden with novel findings on non-Hodgkin lymphoma and skin cancer. Ann Oncol 2014; 25:511-8. [DOI: 10.1093/annonc/mdt544] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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D'Souza A, Theis J, Quint P, Kyle R, Gertz M, Zeldenrust S, Vrana J, Dogan A, Dispenzieri A. Exploring the amyloid proteome in immunoglobulin-derived lymph node amyloidosis using laser microdissection/tandem mass spectrometry. Am J Hematol 2013; 88:577-80. [PMID: 23606017 DOI: 10.1002/ajh.23456] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 03/27/2013] [Accepted: 04/03/2013] [Indexed: 11/07/2022]
Abstract
Amyloidosis affecting lymph nodes (LN) may occur in the setting of systemic amyloidosis or as an entity localized to the site of production (peritumoral). Why some LN amyloid remains peritumoral is unknown. We speculated that the composition of amyloid in these two presentations differs. We analyzed the amyloid proteome in LN amyloid samples to identify differences between the systemic and peritumoral subtypes. In immunoglobulin-derived LN amyloidosis (N = 26), 70% had heavy chain amyloid (AH or mixed AH/AL). True localized LN amyloidosis was rare, with only 2 patients without a monoclonal protein component. Nineteen patients (73%) had typical amyloid syndromes (100% of AL vs 67% of AH/AL, P = 0.02). A trend to improved survival for the AH/AL group in comparison to AL (median 5-year survival 48 vs. 19 months, P = 0.06) was seen. Mass spectrometric amyloid analysis is a powerful tool for characterizing amyloid and may provide additional prognostic information.
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Affiliation(s)
- Anita D'Souza
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Jason Theis
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Patrick Quint
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Robert Kyle
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Morie Gertz
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Steven Zeldenrust
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Julie Vrana
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Ahmet Dogan
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Angela Dispenzieri
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
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D'Souza A, Ansell S, Reeder C, Gertz MA. Waldenström macroglobulinaemia: the key questions. Br J Haematol 2013; 162:295-303. [DOI: 10.1111/bjh.12367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anita D'Souza
- Division of Hematology; Mayo Clinic; Rochester; MN; USA
| | | | - Craig Reeder
- Division of Hematology/Oncology; Mayo Clinic; Scottsdale; AZ; USA
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Kourelis TV, Gertz M, Zent C, Lacy M, Kyle R, Kapoor P, Zeldenrust S, Buadi F, Witzig T, Hayman S, Lust J, Russell S, Lin Y, Rajkumar VS, Kumar S, Leung N, Dingli D, Dispenzieri A. Systemic amyloidosis associated with chronic lymphocytic leukemia/small lymphocytic lymphoma. Am J Hematol 2013; 88:375-8. [PMID: 23508840 DOI: 10.1002/ajh.23413] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 01/26/2013] [Accepted: 02/07/2013] [Indexed: 12/22/2022]
Abstract
To clarify the presentation and course of patients with chronic lymphocytic leukemia (CLL) and amyloidosis. Mayo databases were interrogated for patients who carried a diagnosis of amyloidosis and CLL evaluated at Mayo Clinic, Rochester from January 1974 to October 2012. Charts were abstracted and data analyzed. Of the 33 patients identified, 20 (61%) were diagnosed with AL and 13 (39%) with non-AL. Only four patients had immunoglobulin light chain amyloidosis (AL) that could be solely attributed to the CLL clone; another six had both a plasma cell clone and a CLL clone that shared the same light chain. Median overall survival was 15.6 months for patients with AL and 58.1 months for patients with non-AL. For patients with AL management involved chemotherapy targeted toward monoclonal plasma cells, lymphocytes or both, and for patients with non-AL no specific amyloid treatment was administered. AL is a rare complication of CLL, but in this elderly population of patients non-AL is nearly as common. Distinguishing between these two groups is essential since patients with non-AL amyloidosis have better outcomes and they do not require cytotoxic chemotherapy to treat their amyloidosis.
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Affiliation(s)
| | - Morie Gertz
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Clive Zent
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Martha Lacy
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Robert Kyle
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Prashant Kapoor
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Steven Zeldenrust
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Francis Buadi
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Thomas Witzig
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Suzanne Hayman
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - John Lust
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Stephen Russell
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Yi Lin
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Vincent S. Rajkumar
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Shaji Kumar
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Nelson Leung
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - David Dingli
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
| | - Angela Dispenzieri
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester; Minnesota
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Franco-Palacios D, Tama M, Samaddar S, Yang J. Retroperitoneal amyloidosis as the presenting manifestation of Waldenstrom's macroglobulinaemia. BMJ Case Rep 2013; 2013:bcr2013009329. [PMID: 23616327 PMCID: PMC3645597 DOI: 10.1136/bcr-2013-009329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Retroperitoneal amyloidosis has been described in a few case reports and is typically a secondary manifestation of inflammation or malignancy. We present the case of a 69-year-old man who presented with a large pleural effusion and an incidental retroperitoneal mass in the CT imaging. Further investigation confirmed the diagnosis of amyloid amyloidosis involving the retroperitoneum as well as a concurrent Waldenstrom's macroglobulinaemia. Chemotherapy consistent of drugs active against both the lymphoid and plasma cell components of the disease is the proposed therapy for Waldenstrom's macroglobulinaemia in those patients amenable to receive chemotherapy and can make a difference in the survival.
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21
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Wong E, Chew LP, Seymour JF. A case of chronic lymphocytic leukemia associated with systemic light chain amyloidosis. Leuk Lymphoma 2013; 54:2062-4. [PMID: 23320887 DOI: 10.3109/10428194.2013.765564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chung YY, Wang CC, Lai KJ, Chang CC. Waldenström's macroglobulinemia-associated renal amyloidosis presenting as a solitary lung mass. Ren Fail 2012; 34:1173-6. [PMID: 22950818 DOI: 10.3109/0886022x.2012.717488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A single nodular lesion can be observed in various pulmonary diseases, including cancer, tuberculosis, and fungal infection. Waldenström's macroglobulinemia (WM) usually occurs in older adults and involves the lymph nodes, bone marrow, and spleen. Respiratory tract involvement is very rare. We reported a case of WM-associated renal amyloidosis. The patient was admitted with the initial presentation as a single mass in the lung and progression to renal involvement.
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Affiliation(s)
- Yuan-You Chung
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan
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Abstract
The cardiac involvement and associated mortality that occur in systemic AL amyloidosis remain among the most challenging aspects of the systemic amyloid-related diseases. Monoclonal immunoglobulin light chains produced by a clone of plasma cells are usually the cause of symptoms and organ dysfunction via both poorly understood toxic effects of misfolded species and accumulation of interstitial amyloid fibrils in key viscera. Treatment is aimed at eliminating the clonal cells in order to eliminate toxic light chain production. Recent advances in therapy have helped many patients with AL achieve complete hematologic responses and significant reversal of organ damage but these benefits do not extend to that 10-15 % who present with advanced cardiac involvement. Even with cardiac transplant followed by effective therapy such as stem cell transplant, outcomes for these patients remain promising at best.
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Affiliation(s)
- Giovanni Palladini
- Amyloidosis Research and Treatment Center, Foundation "IRCCS Policlinico San Matteo", and Department of Molecular Medicine, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy,
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Current status of hematopoietic cell transplantation in the treatment of systemic amyloid light-chain amyloidosis. Bone Marrow Transplant 2011; 47:895-905. [DOI: 10.1038/bmt.2011.152] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chuquilin M, Al-Lozi M. Primary amyloidosis presenting as "dropped head syndrome". Muscle Nerve 2011; 43:905-9. [PMID: 21607974 DOI: 10.1002/mus.22049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A 77-year-old man, with a history of lymphoma, presented with isolated neck extensor weakness and a 2-year history of bilateral carpal tunnel syndrome (CTS). Needle electromyography showed myopathic changes, and biopsy of cervical paraspinal muscles showed amyloid deposition in blood vessels. Amyloidosis should be considered in the differential diagnosis of dropped head syndrome.
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Affiliation(s)
- Miguel Chuquilin
- Department of Neurology, Washington University, 660 South Euclid Avenue, Box 8111, St. Louis, Missouri 63110, USA
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Telio D, Bailey D, Chen C, Crump M, Reece D, Kukreti V. Two distinct syndromes of lymphoma-associated AL amyloidosis: a case series and review of the literature. Am J Hematol 2010; 85:805-8. [PMID: 20872959 DOI: 10.1002/ajh.21814] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Light chain (AL) amyloidosis has a rare association with non-Hodgkin lymphoma (NHL). Both peritumoral and systemic AL amyloidosis have been reported, but a detailed description of these syndromes is lacking. We describe 10 patients with lymphoma associated AL amyloidosis. NHL patients with peritumoral amyloidosis had low or undetectable levels of monoclonal (M) protein, mostly single organ involvement(lung or soft tissue), and underlying extranodal marginal zone lymphoma, mucosa associated lymphoid tissue subtype. NHL patients with systemic amyloidosis had high levels of M-protein, multiorgan involvement with frequent cardiac involvement, and predominantly underlying lymphoplasmacytic lymphoma. Systemic amyloidosis was associated with inferior outcomes
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Juncà J, Moreno M, Mate JL, Milla F. Diagnóstico simultáneo de una leucemia aguda mieloide y un síndrome linfoproliferativo crónico, con amiloidosis AA como episodio final. Med Clin (Barc) 2010; 135:136-7. [DOI: 10.1016/j.medcli.2009.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 04/14/2009] [Indexed: 11/27/2022]
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28
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Cohen AD, Comenzo RL. Systemic light-chain amyloidosis: advances in diagnosis, prognosis, and therapy. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2010; 2010:287-294. [PMID: 21239808 DOI: 10.1182/asheducation-2010.1.287] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Systemic light-chain amyloidosis (AL) is caused by misfolded immunoglobulin light-chain proteins that aggregate and deposit as unique fibrils, ultimately leading to organ failure and death. Recent developments that have significantly aided the management of patients with AL include diagnostic techniques for definitive typing of amyloid deposits by use of laser microdissection with mass spectrometry and customized protein bioinformatics, and validated staging and response-scoring systems that improve clinical trial design. The widespread use of cardiac biomarker staging and serum-free light-chain levels to evaluate response to therapy has also improved care. Standard therapies such as oral melphalan and dexamethasone or autologous stem cell transplant continue to be important options, while thalidomide and its analogs, lenalidomide and pomalidomide, and the proteasome-inhibitor bortezomib have activity in AL and have expanded our armamentarium. Continued improvement in outcomes, however, will require the commitment and cooperation of pharmaceutical companies, regulatory agencies, academic investigators, and cooperative groups/consortia. This effort will involve the conduct of well-designed clinical trials of new agents and combinations within a modern framework that categorizes the study populations of patients with AL, defines the end points appropriate to those populations and to the different phases of clinical trials, employs the newly available staging and response criteria, and standardizes adverse event reporting.
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Abstract
Amyloidosis is an uncommon disorder in which proteins change conformation, aggregate, and form fibrils that infiltrate tissues, leading to organ failure and death. The most frequent types are light-chain (AL) derived from monoclonal B-cell disorders producing amyloidogenic immunoglobulin light chains, and the hereditary and "senile systemic" (ATTR) variants from mutant and wild-type transthyretin (TTR). Diagnosis requires tissue biopsy. AL is more frequent and causes more organ disease than ATTR. Although both can cause cardiomyopathy and heart failure, AL progresses more quickly, so survival depends on timely diagnosis. Typing is usually based on clinical and laboratory findings with monoclonal gammopathy evaluation and, if indicated, TTR gene testing. Direct tissue typing is required when one patient has 2 potential amyloid-forming proteins. In coming years, widespread use of definitive proteomics will improve typing. New therapies are in testing for ATTR, whereas those for AL have followed multiple myeloma, leading to improved survival. Challenges of diagnosing and caring for patients with amyloidosis include determination of type, counseling, and delivery of prompt therapy often while managing multisystem disease. Recent advances grew from clinical research and advocacy in many countries, and global husbandry of such efforts will reap future benefits for families and patients with amyloidosis.
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Ustun C, Savage N, Manaloor E, Kunavarapu C, Jillella A. Amyloidosis, Evans syndrome and management options of lymphoplasmacytic lymphoma. Amyloid 2009; 16:42-6. [PMID: 19291514 DOI: 10.1080/13506120802676815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 77-year-old man presented with Evans syndrome (ES), hard palate thickening, gastrointestinal (GI) hemorrhage, acute myocardial infarction (AMI) and pleural and pericardial effusions. The patient responded well to emergent ES treatment with high-dose steroids and intravenous immunoglobulin. Investigation revealed lymphoplasmacytic lymphoma (LPL) as well as amyloidosis in the hard palate, lymph nodes, and pericardium. Considering his age, non-myelosuppressive agents were administered, with the exception of dose-reduced cyclophosphamide. The patient developed neutropenic fever, atrial fibrillation and subsequently died. This report describes the first LPL patient with ES. LPL is generally an indolent disease. However, as in our patient, it can be life threatening because of its complications. ES contributed to his GI hemorrhage, severe anemia, and thus AMI at the time of presentation. Probable cardiac amyloidosis played a role in the latter phase (i.e. cardiac arrhythmia and hypotension during sepsis). Although rare, the presence of ES and amyloidosis should be investigated diligently in elderly LPL patients. Instead of aggressive myelosuppressive chemotherapy agents, targeted therapies might be considered in these fragile patients.
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Affiliation(s)
- Celalettin Ustun
- Department of Medicine, Section of Hematology/Oncology, Medical College of Georgia, 1120 15th Street, Augusta, GA30912, USA.
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AL amyloidosis associated with IgM paraproteinemia: clinical profile and treatment outcome. Blood 2008; 112:4009-16. [DOI: 10.1182/blood-2008-02-138156] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractAL amyloidosis associated with immunoglobulin M (IgM) paraproteinemia is rare. We report 103 consecutive such patients evaluated at the National Amyloidosis Centre (London, United Kingdom) between 1988 and 2006. Renal, cardiac, and lymph node amyloid was present in 53%, 35%, and 21% of patients, respectively, at presentation and 2 or more organs were involved in 54%. Seventy-three percent had an abnormal bone marrow infiltrate (lymphoid in 87%). The median IgM paraprotein was 8 g/L and serum free light chain (FLC) ratio was abnormal in 77 (88%) of 87. The abnormal FLC component was more than 100 mg/L in only 31% cases. Thirty-two percent achieved a partial hematologic response to treatment with no complete responders, and there appeared to be a greater response to combination regimens than single-agent oral alkylators (59% vs 20%, respectively; P = .003). Four achieved amyloidotic organ responses; organ function remained stable in 68%. None with lymph node involvement showed nodal improvement. Median overall survival was 49 months. AL amyloidosis with IgM paraproteinemia represents a distinctive subset of patients with AL amyloidosis who have a wider variety of underlying clonal disorders (often lymphoid) than AL in general, have low-level FLC abnormality, and should be treated with appropriately tailored chemotherapeutic regimens for the underlying clonal disorder.
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Terrier B, Jaccard A, Harousseau JL, Delarue R, Tournilhac O, Hunault-Berger M, Hamidou M, Dantal J, Bernard M, Grosbois B, Morel P, Coiteux V, Gisserot O, Rodon P, Hot A, Elie C, Leblond V, Fermand JP, Fakhouri F. The clinical spectrum of IgM-related amyloidosis: a French nationwide retrospective study of 72 patients. Medicine (Baltimore) 2008; 87:99-109. [PMID: 18344807 DOI: 10.1097/md.0b13e31816c43b6] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin M (IgM)-related amyloidosis remains a rare and little-known complication of monoclonal IgM-associated disorders. We sought to determine the clinical and laboratory presentation, response to treatment, and outcome of patients with IgM-related amyloidosis in the era of new therapeutic approaches. We conducted a retrospective study in 29 French centers to identify patients with monoclonal IgM and biopsy-proven amyloidosis; we reviewed patients' records and collected relevant clinical and laboratory data. We identified 72 patients with IgM-related amyloidosis. Systemic primary amyloidosis (AL) was present in 64, peritumoral AL in 5, and systemic secondary amyloidosis (AA) in 3 patients. A peculiar pattern of relatively frequent lymph node (31%) and lung (17%) involvement was noted in patients with systemic AL amyloidosis. Response to alkylating agents was poor, with a hematologic response in 37%, a complete remission in 0%, and an organ response in 21%. Response to hematopoietic stem cell transplantation showed a hematologic response in 100% with complete remission in 75% and an organ response in 75%. Purine analogs and rituximab induced a hematologic response in 73% and 60%, respectively, with complete remission in 9% and 0% and an organ response in 55% and 0%, respectively. In multivariate analysis, prognostic factors for survival were serum albumin level < or =3.5 g/dL (p = 0.018) and heart involvement (p = 0.0034). Further prospective studies are needed in patients with IgM-related amyloidosis, with special emphasis on treatment options: hematopoietic stem cell transplantation and purine analogs could represent the most effective therapies. The identification of adverse prognostic factors of survival could be useful for those managing and making treatment decisions for these patients.
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Affiliation(s)
- Benjamin Terrier
- From Service de Néphrologie et d'Hématologie (BT, RD, FF), and Service de Biostatistiques (CE), CHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris; Service d'Hématologie Clinique (AJ), Centre de Référence des Amyloses Primitives et des Autres Maladies de Dépô t d'Immunoglobuline, CHU, Limoges; Service d'Hématologie (JLH), Service de Médecine Interne (MH), and Service de Néphrologie (JD), CHU Hôtel-Dieu, Nantes; Service d'Hématologie (OT), CHU, Clermont-Ferrand; Service d'Hématologie (MHB), CHU, Angers; Service d'Hématologie (MB) and Service de Médecine Interne (BG), CHU, Rennes; Service d'Hématologie (PM), Hôpital, Lens; Service d'Hématologie (VC), CHRU Claude Huriez, Lille; Service d'Hématologie et Médecine Interne (OG), Hôpital Saint-Anne, Toulon; Service d'Hématologie (PR), Hôpital, Blois; Service de Médecine Interne (AH), CHU, Lyon; Service d'Hématologie (VL), CHU Pitié- Salpétrière, Paris; and Service d'Immuno-Hématologie (JPF), CHU Saint-Louis, Paris, France
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Calreticulin expression in the clonal plasma cells of patients with systemic light-chain (AL-) amyloidosis is associated with response to high-dose melphalan. Blood 2007; 111:549-57. [PMID: 17982021 DOI: 10.1182/blood-2007-05-090852] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In high doses with stem-cell transplantation, melphalan is an effective but toxic therapy for patients with systemic light-chain (AL-) amyloidosis, a protein deposition and monoclonal plasma cell disease. Melphalan can eliminate the indolent clonal plasma cells that cause the disease, an achievement called a complete response. Such a response is usually associated with extended survival, while no response (a less than 50% reduction) is not. Gene-expression studies and a stringently supervised analysis identified calreticulin as having significantly higher expression in the pretreatment plasma cells of patients with systemic AL-amyloidosis who then had a complete response to high-dose melphalan. Calreticulin is a pleiotropic calcium-binding protein found in the endoplasmic reticulum and the nucleus whose overexpression is associated with increased sensitivity to apoptotic stimuli. Real-time PCR and immunohistochemical staining also showed that expression of calreticulin was higher in the plasma cells of those with a complete response. Furthermore, wild-type murine embryonic fibroblasts were significantly more sensitive to melphalan than calreticulin knock-out murine embryonic fibroblasts. These data have important implications for understanding the activity of melphalan in plasma-cell diseases and support further investigation of calreticulin and its modulation in patients with systemic AL-amyloidosis receiving high-dose melphalan.
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Recommendations for use of Tumor Markers in Monoclonal Gammopathies. J Med Biochem 2007. [DOI: 10.2478/v10011-007-0020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Preporuke za Primenu Tumorskih Markera Kod Monoklonskih GamapatijaMonoklonske gamapatije čine grupu poremećaja koji se karakterišu klonskom proliferacijom plazma ćelija. M protein je tumorski marker specifičan za monoklonske gamapatije jer odražava klonsku produkciju imunoglobulina. Monoklonske gamapatije uključuju: multipli mijelom,Waldenström-ovu makroglobulinemiju (WM), nesekretorni mijelom, prikriveni (smoldering) multipli mijelom, monoklonsku gamapatiju od neodređenog značaja (MGUS,Monoclonal gammopathy of undetermined significance), primarnu sistemsku amiloidozu i bolest teških lanaca. Dijagnoza multiplog mijeloma je zasnovana na detekciji M proteina u serumu i/ili urinu, infiltraciji plazma ćelija u koštanoj srži i litičkim koštanim lezijama na radiografiji skeleta. Prema NACB (National Academy of Clinical Biochemistry) preporukama, tumorski markeri za dijagnozu,screening, identifikaciju klonaliteta, praćenje bolesti i prognostičku evaluaciju kod monoklonskih gamapatija su: elektroforeza proteina u serumu i/ili urinu, imunofiksacija u serumu i/ili urinu, slobodni laki lanci (SLL) u serumu i/ili urinu, viskoznost seruma i β2-mikroglobulin. Imunofiksacija se koristi za identifikaciju klonaliteta (tipa) M proteina primećenog na elektroforezi i kada postoji sumnja bez obzira na normalan proteinski elektroforetogram. Posebno je korisna za prepoznavanje i razlikovanje biklonskih ili triklonskih gamapatija. Viskoznost seruma trebalo bi određivati ako pacijent ima znake i simptome sindroma hiperviskoznosti. WM je najčeŠći uzrok hiperviskoznosti, ali se takođe može pojaviti i kod pacijenata sa velikim nivoima monoklonskog IgA ili IgG. Automatizovana imunoodređivanja SLL u serumu su osetljivija od tradicionalne elektroforetske metode i imunofiksacije za detekciju mijeloma monoklonskih lakih lanaca, nesekretornog mijeloma i AL amiloidoze. Osim toga, odnos SLL u serumu je nezavisan faktor rizika za nastanak maligne progresije kod pacijenata sa MGUS. Određivanje SLL u serumu i elektroforeze proteina seruma kao testova prve linije za razmatranje prisustva mogućih poremećaja B ćelija daje dodatnu dijagnostičku informaciju.
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Abstract
Amyloidosis is a disease in which abnormal proteins form fibrillar tissue deposits that can compromise key viscera and lead to early death. In order to treat amyloidosis, the type of abnormal protein must be identified. The most common type is monoclonal immunoglobulin light chain or AL amyloidosis; the other important type is hereditary, caused by variant forms of transthyretin and other proteins, whereas amyloid associated with chronic inflammation ("secondary") is rare in the developed world. AL can be misdiagnosed if a monoclonal gammopathy and a hereditary variant are present in the same patient. The aim of therapy in systemic AL amyloidosis is to reduce the amyloid-forming monoclonal light chain, measured with the serum free light chain assay, by suppressing the underlying plasma cell dyscrasia, while using supportive measures to sustain organ function. Amyloid deposits can be resorbed and organ function restored if the amyloid-forming precursor light chain is eliminated. The most effective treatment for systemic AL amyloidosis is risk-adapted melphalan with peripheral blood stem cell transplant (SCT). The hematologic response rate is 75% at 12 months when adjuvant therapy with thalidomide and dexamethasone is used post-SCT. Patients can achieve long-term durable remissions with organ recovery. Drugs effective in multiple myeloma are usually helpful in AL amyloidosis if tolerated. The use of novel antibody-based approaches for imaging amyloid and possibly for accelerating removal of deposits is under active investigation.
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Affiliation(s)
- Raymond L Comenzo
- Hematology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Sanchorawala V, Blanchard E, Seldin DC, O'Hara C, Skinner M, Wright DG. AL amyloidosis associated with B-cell lymphoproliferative disorders: frequency and treatment outcomes. Am J Hematol 2006; 81:692-5. [PMID: 16795060 DOI: 10.1002/ajh.20635] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AL amyloidosis, a systemic disorder characterized by widespread deposition of amyloid fibrils derived from monoclonal Ig light chains in organs and soft tissues, is typically caused by an underlying plasma cell dyscrasia. However, this disease can also be associated rarely with a B-cell lymphoproliferative disorder. In this report, we describe the presentation and clinical course of 16 patients with this association. Although amyloid-related organ involvement in these patients was typical of AL amyloidosis, the patients in this series were on average older and more likely to be female than patients with disease associated with a plasma cell dyscrasia. They were also more likely to have multisystem involvement. Treatment decisions were based primarily on the dominent hematopathologic features of the associated lymphoproliferative disorder. However, high-dose melphalan and stem cell transplantation was the primary therapy in 5 patients, and each of these patients had prolonged survival, ranging from 36 to 102 months.
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Affiliation(s)
- V Sanchorawala
- Department of Medicine, Boston University Medical Center, Boston, MA, USA.
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Dauchy FA, Etienne G, Deminière C, Combe C, Merville P, Longy-Boursier M. [Lymphoma with initial renal involvement: four cases]. Rev Med Interne 2006; 27:909-15. [PMID: 16952412 DOI: 10.1016/j.revmed.2006.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Revised: 07/06/2006] [Accepted: 07/24/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To present a comprehensive description of the clinical features of patients with renal manifestations during lymphoma. METHODS Retrospective review of medical records from all patients diagnosed with lymphoma associated with kidney involvement in our hospital between 1996 to 2004. Four cases were identified and analysed. RESULTS Four patients presented a non-Hodgkin's lymphoma. One patient showed intravascular large B-cell lymphoma, revealed by proteinuria. Another patient had a nephrotic syndrome, and two had a renal mass. Renal histology allowed diagnosis of lymphoma in 3 cases. CONCLUSION The diagnosis of lymphoma associated with renal involvement is rather difficult, and more specifically in case of intravascular large B-cell lymphoma, or even primary renal lymphoma. We present here a comprehensive review of the literature and we discuss pathogenesis of these conditions.
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Affiliation(s)
- F-A Dauchy
- Médecine interne et maladies tropicales, hôpital Saint-André, CHU de Bordeaux, université Bordeaux-II, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France.
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Gono T, Yazaki M, Fushimi T, Suzuki T, Uehara T, Sano K, Kametani F, Ito N, Matsushita M, Nakamura S, Hoshii Y, Matsuda M, Ikeda SI. AH Amyloidosis Associated With Lymphoplasmacytic Lymphoma Secreting a Monoclonal γ Heavy Chain Carrying an Unusual Truncated D Segment. Am J Kidney Dis 2006; 47:908-14. [PMID: 16632032 DOI: 10.1053/j.ajkd.2006.02.174] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 02/07/2006] [Indexed: 11/11/2022]
Abstract
To date, the presence of amyloidosis associated with immunoglobulin heavy chain (AH amyloidosis) was reported in only 7 cases. Although AH amyloidosis is caused mainly by plasma cell dyscrasia, as in AL amyloidosis, we report a 61-year-old patient who presented with nephrotic syndrome caused by AH amyloidosis associated with lymphoplasmacytic lymphoma. Biochemical and molecular analyses of the deposited amyloid fibrils and heavy-chain genes of lymphocytes showed that proliferative lymphoma cells produced a gamma heavy chain, not a mu heavy chain, which carried an unusual truncated diversity (D) segment of the variable region. Our results indicate that production of the abnormal heavy chain caused by the partially deleted D segment gene is responsible for gamma heavy-chain-related amyloid fibril formation in this patient.
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Affiliation(s)
- Takahisa Gono
- Third Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Comenzo RL, Zhou P, Fleisher M, Clark B, Teruya-Feldstein J. Seeking confidence in the diagnosis of systemic AL (Ig light-chain) amyloidosis: patients can have both monoclonal gammopathies and hereditary amyloid proteins. Blood 2006; 107:3489-91. [PMID: 16439680 DOI: 10.1182/blood-2005-10-4148] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Investigators in the United Kingdom have shown that hereditary amyloidosis can be misdiagnosed as Ig light-chain (AL) amyloidosis because family history is an ineffective screen, and tissue staining used to type amyloid is unreliable. Misdiagnosis of AL can lead to inappropriate use of chemotherapy and failure to diagnose a hereditary disease. Over a 3-year period we sought to determine how often both possible sources of amyloidosis occurred in the same patient. We employed an algorithm based on established data and patterns of amyloidosis in order to focus the screening effort. Of 178 consecutive patients referred for amyloidosis, 54 were screened by polymerase chain reaction techniques with primers designed to detect transthyretin, apolipoprotein AI, apolipoprotein AII, fibrinogen Aalpha, and lysozyme variants. Three patients (6% of those screened and 2% of symptomatic patients) had both a monoclonal gammopathy and a hereditary variant. These results justify further study of screening for hereditary variants in patients with apparent AL, and highlight the need for practical techniques for identifying fibrils extracted from tissue.
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Affiliation(s)
- Raymond L Comenzo
- Howard 802, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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Abstract
Chronic lymphocytic leukemia (CLL), the most common form of leukemia in Western countries, rarely induces glomerular disease, but membranoproliferative glomerulonephritis or immunotactoid glomerulopathy has been reported. The proliferating cells in CLL are of mature B-cell origin and produce monoclonal immunoglobulin (Ig), thus leading to various kinds of autoimmune disorders or immunotactoid glomerulopathy. Although there have been a few reported cases of amyloidosis accompanying CLL, the type of amyloid fibrils has not been demonstrated nor described in detail, particularly regarding monoclonal Ig productivity. We report a rare case of amyloidosis associated with CLL, in which we detected ?-light chain type monoclonal Ig in the sera, urine, and on the surface membrane of lymphocytes, and discuss an association between monoclonal Ig-related disease and non-Hodgkin's lymphoma.
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Affiliation(s)
- Ryota Ikee
- Second Department of Internal Medicine, National Defense Medical College, Saitama, Japan
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