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Liu JW, Tan Y, Chen T, Qian YT, Ma DL. Systemic amyloidosis presented with leonine facies. QJM 2024; 117:287-288. [PMID: 38060280 DOI: 10.1093/qjmed/hcad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Jia-Wei Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing 100730, China
| | - Yan Tan
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing 100730, China
| | - Tian Chen
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing 100730, China
| | - Yue-Tong Qian
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing 100730, China
| | - Dong-Lai Ma
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing 100730, China
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Levin D, Lewis E, McCulloch S, Lee H, Tay J, Duggan P, Neri P, Bahlis N, Jimenez-Zepeda VH. Daratumumab for the treatment of relapsed/refractory AL amyloidosis: experience from the amyloidosis Program of Calgary (APC). Leuk Lymphoma 2024; 65:403-406. [PMID: 38054823 DOI: 10.1080/10428194.2023.2290468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Daniel Levin
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Ellen Lewis
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Sylvia McCulloch
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Holly Lee
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Jason Tay
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
| | - Peter Duggan
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
| | - Paola Neri
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
| | - Nizar Bahlis
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
| | - Victor H Jimenez-Zepeda
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
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Goldis R, Kaplan B, Arad M, Dispenzieri A, Dasari S, Kukuy OL, Simon AJ, Dori A, Shavit-Stein E, Ziv T, Murray D, Kourelis T, Gertz MA, Dominissini D, Magen H, Muchtar E. Amino acid sequence homology of monoclonal serum free light chain dimers and tissue deposited light chains in AL amyloidosis: a pilot study. Clin Chem Lab Med 2024; 62:464-471. [PMID: 37747270 DOI: 10.1515/cclm-2023-0591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Diagnosis of light chain amyloidosis (AL) requires demonstration of amyloid deposits in a tissue biopsy followed by appropriate typing. Previous studies demonstrated increased dimerization of monoclonal serum free light chains (FLCs) as a pathological feature of AL. To further examine the pathogenicity of FLC, we aimed at testing amino acid sequence homology between circulating and deposited light chains (LCs). METHODS Matched tissue biopsy and serum of 10 AL patients were subjected to tissue proteomic amyloid typing and nephelometric FLC assay, respectively. Serum FLC monomers (M) and dimers (D) were analyzed by Western blotting (WB) and mass spectrometry (MS). RESULTS WB of serum FLCs showed predominance of either κ or λ type, in agreement with the nephelometric assay data. Abnormal FLC M-D patterns typical of AL amyloidosis were demonstrated in 8 AL-λ patients and in one of two AL-κ patients: increased levels of monoclonal FLC dimers, high D/M ratio values of involved FLCs, and high ratios of involved to uninvolved dimeric FLCs. MS of serum FLC dimers showed predominant constant domain sequences, in concordance with the tissue proteomic amyloid typing. Most importantly, variable domain sequence homology between circulating and deposited LC species was demonstrated, mainly in AL-λ cases. CONCLUSIONS This is the first study to demonstrate homology between circulating FLCs and tissue-deposited LCs in AL-λ amyloidosis. The applied methodology can facilitate studying the pathogenicity of circulating FLC dimers in AL amyloidosis. The study also highlights the potential of FLC monomer and dimer analysis as a non-invasive screening tool for this disease.
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Affiliation(s)
- Rivka Goldis
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Batia Kaplan
- Institute of Hematology and Sheba Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
| | - Michael Arad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Heart Failure Institute, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | | | - Surendra Dasari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Olga Lesya Kukuy
- Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan, Israel
| | - Amos J Simon
- Institute of Hematology and Sheba Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
| | - Amir Dori
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Shavit-Stein
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Ziv
- Smoler Protein Center, Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel
| | - David Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Dan Dominissini
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Genomics Unit, Sheba Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
- Wohl Institute of Translational Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Hila Magen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Multiple Myeloma Unit, Hematology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Makazu M, Sasaki A, Ichita C, Sumida C, Nishino T, Nagayama M, Teshima S. Systemic AL amyloidosis with multiple submucosal hematomas of the colon: a case report and literature review. Clin J Gastroenterol 2024; 17:69-74. [PMID: 37924463 DOI: 10.1007/s12328-023-01880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
Amyloid light-chain (AL) amyloidosis rarely causes colorectal submucosal hematoma. A 76-year-old man presented with a complaint of bloody stool. An initial colonoscopy revealed ulcerative lesions in the descending colon, leading to a diagnosis of ischemic colitis. One month later, he presented with cardiac failure, suspected cardiac amyloidosis, and underwent a second colonoscopy. Although it revealed multiple ulcerative lesions from the ascending to transverse colon, biopsy samples did not confirm amyloid deposition. He underwent a third colonoscopy 3 weeks later due to recurrent bloody stool. It showed multiple submucosal hematomas from the ascending to descending colon concomitant with ulcerative lesions in the descending colon and multiple elevated lesions in the sigmoid colon. Biopsy samples confirmed amyloid deposition. Using a systemic search, multiple myeloma with AL amyloidosis was diagnosed. Colorectal submucosal or intramural hematomas are conditions usually encountered in trauma, antithrombotic use, or coagulation disorders. Based on our review of the literatures, we identified several differences between colorectal intramural hematoma caused by amyloidosis and those caused by other etiologies. We believe that amyloidosis should be considered when relatively small and multiple colorectal hematomas, not restricted to the sigmoid colon, and with concomitant findings of erosions and ulcers, are observed.
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Affiliation(s)
- Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Chihiro Sumida
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Miki Nagayama
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Shinichi Teshima
- Department of Diagnostic Pathology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
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Gertz MA. Immunoglobulin light chain amyloidosis: 2024 update on diagnosis, prognosis, and treatment. Am J Hematol 2024; 99:309-324. [PMID: 38095141 DOI: 10.1002/ajh.27177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
DISEASE OVERVIEW Immunoglobulin light chain amyloidosis is a clonal, nonproliferative plasma cell disorder in which fragments of immunoglobulin light or heavy chain are deposited in tissues. Clinical features depend on organs involved but can include heart failure with preserved ejection fraction, nephrotic syndrome, hepatic dysfunction, peripheral/autonomic neuropathy, and "atypical smoldering multiple myeloma or MGUS." DIAGNOSIS Tissue biopsy stained with Congo red demonstrating amyloid deposits with apple-green birefringence is required for the diagnosis of AL amyloidosis. Organ biopsy is not required in 85% of patients. Verification that amyloid is composed of immunoglobulin light chains is mandatory. The gold standard is laser capture mass spectroscopy. PROGNOSIS N-terminal pro-brain natriuretic peptide (NT-proBNP or BNP), serum troponin T(or I), and difference between involved and uninvolved immunoglobulin free light chain values are used to classify patients into four stages; 5-year survivals are 82%, 62%, 34%, and 20%, respectively. THERAPY All patients with a systemic amyloid syndrome require therapy to prevent deposition of amyloid in other organs and prevent progressive organ failure. Current first-line therapy with the best outcome is daratumumab, bortezomib, cyclophosphamide, and dexamethasone. The goal of therapy is a ≥VGPR. In patients failing to achieve this depth of response options for consolidation include pomalidomide, stem cell transplantation, venetoclax, and bendamustine. FUTURE CHALLENGES Delayed diagnosis remains a major obstacle to initiating effective therapy prior to the development of end-stage organ failure. Trials of antibodies to deplete deposited fibrils are underway.
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Affiliation(s)
- Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Gaba M, Kumar N, Pandey A, Dewan A. An interesting case of AL amyloidosis and MM: a complex scenario with cardiac involvement. BMJ Case Rep 2024; 17:e256012. [PMID: 38272507 PMCID: PMC10826505 DOI: 10.1136/bcr-2023-256012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Our patient presented with complaints of progressive shortness of breath for 1 month. She was diagnosed with a case of infiltrative type of restrictive cardiomyopathy (RCM) based on echocardiography and cardiac MRI findings. Her fat pad biopsy was suggestive of AL type of amyloidosis (AL). She was diagnosed with a case of multiple myeloma (MM) based on bone marrow biopsy findings with 48% plasma cells and a skeletal survey with lytic bone lesions on the skull, thus meeting the Crab criteria. We want to highlight the complex nature of this case and the difficulties associated with making a diagnosis. This case report presents an excellent opportunity to touch on the interesting topics of RCM, amyloidosis and MM.
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Affiliation(s)
- Manish Gaba
- Internal Medicine, Max Smart Super Speciality Hospital, New Delhi, Delhi, India
| | - Naveen Kumar
- Internal Medicine, Max Smart Super Speciality Hospital, New Delhi, Delhi, India
| | - Ankita Pandey
- Internal Medicine, Max Smart Super Speciality Hospital, New Delhi, Delhi, India
| | - Arun Dewan
- Internal Medicine, Max Smart Super Speciality Hospital, New Delhi, Delhi, India
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Shen K, Tian Z, Gao Y, Wang Y, Huo L, Li J, Zhang Y, Zhang S. Chinese consensus on the diagnosis and treatment of immunoglobulin light-chain cardiac amyloidosis. Chin Med J (Engl) 2024; 137:127-129. [PMID: 38146261 PMCID: PMC10798685 DOI: 10.1097/cm9.0000000000002961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
- Kaini Shen
- Department of Hematology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhuang Tian
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yajuan Gao
- Department of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yining Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Li Huo
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian Li
- Department of Hematology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yun Zhang
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- Cardiovascular Disease Research Center of Shandong First Medical University, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250013, China
| | - Shuyang Zhang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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8
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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. Am J Case Rep 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Oubari S, Hegenbart U, Schoder R, Steinhardt M, Papathanasiou M, Rassaf T, Thimm A, Hagenacker T, Naser E, Duhrsen U, Reinhardt HC, Kortum M, Agis H, Schonland S, Carpinteiro A. Daratumumab in first-line treatment of patients with light chain amyloidosis and Mayo stage IIIb improves treatment response and overall survival. Haematologica 2024; 109:220-230. [PMID: 37439344 PMCID: PMC10772504 DOI: 10.3324/haematol.2023.283325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
Treatment of patients with Mayo stage IIIb light chain (AL) amyloidosis is still challenging, and the prognosis remains very poor. Mayo stage IIIb patients were excluded from the pivotal trial leading to the approval of daratumumab in combination with bortezomib-cyclophosphamide-dexamethasone. This retrospective, multicenter study evaluates the addition of daratumumab to first-line therapy in patients with newly diagnosed stage IIIb AL amyloidosis. In total, data from 119 consecutive patients were analyzed, 27 patients received an upfront treatment including daratumumab, 63 a bortezomibbased regimen without daratumumab, eight received therapies other than daratumumab or bortezomib and 21 pretreated patients or deceased prior to treatment were excluded. In the daratumumab group, median overall survival was not reached after a median follow-up time of 14.5 months, while it was significantly worse in the bortezomib- and the otherwise treated group (6.6 and 2.2 months, respectively) (P=0.002). Overall hematologic response rate at 2 and 6 months was better in the daratumumab group compared to the bortezomib group (59% vs. 37%, P=0.12, 67% vs. 41%, P=0.04, respectively). Landmark survival analyses revealed a significantly improved overall survival in patients with partial hematologic response or better, compared to non-responders. Cardiac response at 6 months was 46%, 21%, 0% in the daratumumab-, bortezomib- and otherwise treated groups, respectively (P=0.04). A landmark survival analysis revealed markedly improved overall survival in patients with cardiac very good partial response vs. cardiac non-responders (P=0.002). This study demonstrates for the first time the superiority of an upfront treatment with daratumumab over standard-of-care in stage IIIb AL amyloidosis.
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Affiliation(s)
- Sara Oubari
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Interdisciplinary Amyloidosis Network, University Hospital Essen, University Duisburg-Essen, Essen
| | - Ute Hegenbart
- Department of Internal Medicine V, Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg
| | - Renate Schoder
- Department of Internal Medicine I, Division Hematology and Hemostaseology, Medical University Vienna, Vienna, Austria
| | | | - Maria Papathanasiou
- Interdisciplinary Amyloidosis Network, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen
| | - Andreas Thimm
- Interdisciplinary Amyloidosis Network, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Department of Neurology and Center for Translational Neuro- and Behavioral Science, University Hospital Essen, Essen
| | - Tim Hagenacker
- Interdisciplinary Amyloidosis Network, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Department of Neurology and Center for Translational Neuro- and Behavioral Science, University Hospital Essen, Essen
| | - Eyad Naser
- Institute of Molecular Biology, University of Duisburg-Essen, Essen
| | - Ulrich Duhrsen
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen
| | - Hans C Reinhardt
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen
| | - Martin Kortum
- Department of Hematology, University Hospital Wurzburg, Wurzburg
| | - Hermine Agis
- Department of Internal Medicine I, Division Hematology and Hemostaseology, Medical University Vienna, Vienna, Austria
| | - Stefan Schonland
- Department of Internal Medicine V, Amyloidosis Center Heidelberg, University Hospital Heidelberg, Heidelberg
| | - Alexander Carpinteiro
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Interdisciplinary Amyloidosis Network, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Institute of Molecular Biology, University of Duisburg-Essen, Essen.
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10
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Ramachandran R, Grantham T, Isaac-Coss G, Etienne D, Reddy M. Gastroduodenal Involvement in AL Amyloidosis: Case Report and Literature Review. J Investig Med High Impact Case Rep 2024; 12:23247096241237759. [PMID: 38462925 PMCID: PMC10929022 DOI: 10.1177/23247096241237759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 03/12/2024] Open
Abstract
Gastrointestinal amyloidosis is a rare condition commonly found in the setting of systemic AL amyloidosis. Amyloid can deposit throughout the gastrointestinal tract and the resulting symptoms vary depending on the site of deposition. Gastrointestinal (GI) manifestations can range from weight loss or abdominal pain, to more serious complications like gastrointestinal bleeding, malabsorption, dysmotility, and obstruction. This case describes a patient with known history of IgG lambda AL amyloidosis, presenting with epigastric pain and unintentional weight loss found to have gastroduodenal amyloidosis. The definitive diagnosis of GI amyloidosis requires endoscopic biopsy with Congo red staining and visualization under polarized light microscopy. There are currently no specific guidelines for the management of GI amyloidosis. Generally, the goal is to treat the underlying cause of the amyloidosis along with symptom management. Our patient is being treated with cyclophosphamide, bortezomib, and dexamethasone (CyBorD) and started on hemodialysis due to progression of renal disease.
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D'Souza A. Amyloid consults do not have to be vexing. Hematology Am Soc Hematol Educ Program 2023; 2023:407-412. [PMID: 38066929 PMCID: PMC10727086 DOI: 10.1182/hematology.2023000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Diagnosing amyloidosis can be challenging due to its clinical heterogeneity, need for multiple specialists to make a diagnosis, and lack of a single diagnostic test for the disease. Patients are often diagnosed late, in advanced stage, and after exhibiting multiple symptoms and signs for a long period. It is important to develop a clinical suspicion of amyloidosis, particularly in those with multisystemic symptoms and high-risk patient populations such as those with precursor hematologic conditions. A systematic approach to the workup of suspected amyloidosis is key, including a comprehensive clinical assessment, laboratory tests to assess organ involvement, advanced imaging studies, screening for plasma cell disorder, and tissue biopsy when necessary. After making a diagnosis of amyloidosis, accurate typing of amyloid deposits, differentiating between localized and systemic amyloidosis, and appropriately staging the disease is important. Early diagnosis is crucial for improving patient outcomes and quality of life in light chain amyloidosis.
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Affiliation(s)
- Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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12
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Brunger AF, van Rheenen R, Gans ROB, Hazenberg BPC, Nienhuis HLA. How well does liver span as part of the consensus criteria for liver involvement in AL amyloidosis perform? Amyloid 2023; 30:437-439. [PMID: 37318263 DOI: 10.1080/13506129.2023.2222878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Anne F Brunger
- Departments of Rheumatology & Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, the Netherlands
| | - Ronald van Rheenen
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, the Netherlands
- Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
- Department of Nuclear Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Reinold O B Gans
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, the Netherlands
- Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Bouke P C Hazenberg
- Departments of Rheumatology & Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans L A Nienhuis
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, the Netherlands
- Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
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13
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Liu Y, Leung N, Lu J. Systemic light chain amyloidosis: the hope for a cure. Sci Bull (Beijing) 2023; 68:2678-2681. [PMID: 37884428 DOI: 10.1016/j.scib.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Yang Liu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Nelson Leung
- Division on Nephrology and Hypertension, Division of Hematology, Mayo Clinic, Rochester MN 55905, USA
| | - Jin Lu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China.
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14
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Bal S, Estrada-Merly N, Costa LJ, Qazilbash MH, Kumar S, D'Souza A. Outcomes of t(11;14) light chain (AL) amyloidosis after autologous stem cell transplantation: benchmark for new therapies. Blood Cancer J 2023; 13:170. [PMID: 37968258 PMCID: PMC10651880 DOI: 10.1038/s41408-023-00945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Susan Bal
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Noel Estrada-Merly
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Luciano J Costa
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Muzaffar H Qazilbash
- Division of Cancer Medicine, Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, TX, USA
| | - Shaji Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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15
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Mauermann ML, Clarke JO, Litchy WJ, Obici L, Lousada I, Gertz MA. Peripheral Nervous, Hepatic, and Gastrointestinal Endpoints for AL Amyloidosis Clinical Trials: Report from the Amyloidosis Forum Multi-organ System Working Group. Adv Ther 2023; 40:4695-4710. [PMID: 37658177 PMCID: PMC10567953 DOI: 10.1007/s12325-023-02637-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 09/03/2023]
Abstract
Systemic immunoglobulin light chain (AL) amyloidosis is a heterogeneous rare disease driven by a destructive monoclonal gammopathy and typified by misfolded immunoglobulin light and/or heavy chains which aggregate and deposit in organs as insoluble amyloid fibrils. Disease heterogeneity is driven by the degree of multi-systemic involvement; cardiac, renal, neurological, and gastrointestinal (GI) systems are affected to varying degrees in different patients. While prognosis is primarily driven by hematologic response to treatment and outcomes associated with cardiac events and overall survival, the involvement of the peripheral nervous, hepatic, and GI systems can also have a significant impact on patients. The Amyloidosis Forum ( https://amyloidosisforum.org ) is a public-private partnership between the nonprofit Amyloidosis Research Consortium ( www.arci.org ) and the US Food and Drug Administration (FDA) Center for Drug Evaluation and Research formed to advance drug development for the treatment of systemic amyloid disorders. A series of virtual workshops focused on the development of novel, patient-relevant endpoint components and analytical strategies for clinical trials in AL amyloidosis. This review summarizes the proceedings and recommendations of the Multi-Systemic Working Group which identified, reviewed, and prioritized endpoints relevant to the impacts of AL amyloidosis on the peripheral nervous, hepatic, and GI systems. The Working Group comprised amyloidosis experts, patient representatives, statisticians, and representatives from the FDA, Medicines and Healthcare products Regulatory Agency (MHRA), and pharmaceutical companies. Prioritized neuropathy/autonomic endpoints included a modified form of the Neuropathy Impairment Score (NIS + 7) and the Composite Autonomic Symptom Score (COMPASS-31), respectively. Alkaline phosphatase was identified as the most relevant indicator of liver involvement and disease progression. Following extensive review of potential GI endpoints, the Working Group identified multiple exploratory endpoints. These recommended components will be further explored through evaluation of clinical trial datasets and possible integration into composite endpoint analysis.
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Affiliation(s)
| | | | | | - Laura Obici
- University of Pavia, IRCCS University Hospital Policlinico San Matteo, Pavia, Italy
| | - Isabelle Lousada
- Amyloidosis Research Consortium, 320 Nevada Street, Suite 210, Newton, MA, 02460, USA.
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16
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Charles DD, Pavlisko EN, Neff JL, Kang Y, Carney JM. Coinciding kappa AL amyloidosis and kappa light chain deposition disease in the lung. Virchows Arch 2023; 483:705-707. [PMID: 37535125 DOI: 10.1007/s00428-023-03610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/30/2023] [Accepted: 07/23/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Derald D Charles
- Department of Pathology, Duke University Health System, Durham, NC, USA
| | | | - Jadee L Neff
- Department of Pathology, Duke University Health System, Durham, NC, USA
| | - Yubin Kang
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - John M Carney
- Department of Pathology, Duke University Health System, Durham, NC, USA.
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA.
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17
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Mellqvist UH, Cai Q, Hester LL, Grövdal M, Börsum J, Rahman I, Ammann EM, Hansson M. Epidemiology and clinical outcomes of light-chain amyloidosis in Sweden: A nationwide population-based study. Eur J Haematol 2023; 111:697-705. [PMID: 37533343 DOI: 10.1111/ejh.14063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES This study evaluated data from six Swedish national registries to fill current evidence gaps on the epidemiology, clinical burden, and overall survival (OS) associated with light-chain (AL) amyloidosis. METHODS Patients newly diagnosed with AL amyloidosis were identified using six linked Swedish nationwide population-based registers. For each case, individuals from the general population were selected and matched with a maximum ratio of 1:5 based on age, sex, calendar year, and county. RESULTS 846 patients newly diagnosed with AL amyloidosis and 4227 demographically matched individuals were identified. From 2011 to 2019, annual AL amyloidosis incidence increased from 10.5 to 15.1 cases per million. At baseline, patients with AL amyloidosis had a significantly higher disease burden including higher rates of cardiac and renal failure relative to the comparison group. Among patients with AL amyloidosis, 21.5% had incident heart failure and 17.1% had incident renal failure after initial diagnosis. Median OS for patients with AL amyloidosis was 56 months versus not reached in the matched general population comparison group. CONCLUSION The incidence of newly diagnosed AL amyloidosis in Sweden increased over time with AL amyloidosis being associated with a higher risk of cardiac/renal failure and all-cause mortality compared with the general population.
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Affiliation(s)
- Ulf-Henrik Mellqvist
- Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Qian Cai
- Janssen Global Services, Titusville, New Jersey, USA
| | - Laura L Hester
- Janssen Research & Development, Horsham, Pennsylvania, USA
| | | | | | | | | | - Markus Hansson
- Department of Hematology, Sahlgrenska Academy, Göteborg University and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Hematology, Skåne University Hospital, Lund, Sweden
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18
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Gustine JN, Staron A, Mendelson L, Joshi T, Gopal DM, Siddiqi OK, Ruberg FL, Sanchorawala V. Predictors of treatment response and survival outcomes in patients with advanced cardiac AL amyloidosis. Blood Adv 2023; 7:6080-6091. [PMID: 37581513 PMCID: PMC10582303 DOI: 10.1182/bloodadvances.2023010324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 08/16/2023] Open
Abstract
Patients with advanced cardiac immunoglobulin light chain (AL) amyloidosis have a poor prognosis. Early hematologic and cardiac responses can prolong survival, but predictors of these outcomes have yet to be clarified. We report on 142 patients with newly diagnosed stage IIIb AL amyloidosis. After a median follow-up of 60 months, the median overall survival (OS) was 9 months. Independent baseline factors associated with shorter OS were symptom onset to diagnosis >6 months (hazard ratio [HR], 1.94; P = .003); bone marrow plasmacytosis ≥ 10% (HR, 1.98; P = .01); troponin I > 0.635 ng/mL (HR, 1.62; P = .04); New York Heart Association class III or IV (HR, 1.67; P = .04); and 6-minute walk test distance < 200 m (HR, 1.85; P = .01). Early hematologic (within 1 month) and cardiac (within 3 months) responses were significantly associated with longer survival. In a 1-month landmark analysis, patients with a hematologic very good partial response, partial response, and no response had a median OS of 47, 25, and 5 months, respectively (P < .0001). Patients with cardiac response at 3 months had significantly longer OS (47 vs 11 months; P < .0001). On multivariable modeling, bortezomib use was associated with early hematologic and cardiac responses and longer OS. Symptom onset to diagnosis duration of >6 months and difference between the involved and uninvolved free light chain > 350 mg/L were independently associated with lower odds of an early cardiac response. This study identified factors predictive of treatment outcomes and survival in advanced cardiac AL amyloidosis.
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Affiliation(s)
- Joshua N. Gustine
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
| | - Andrew Staron
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
- Section of Hematology and Medical Oncology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
| | - Lisa Mendelson
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
- Section of Hematology and Medical Oncology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
| | - Tracy Joshi
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
- Section of Hematology and Medical Oncology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
| | - Deepa M. Gopal
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
| | - Omar K. Siddiqi
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
| | - Frederick L. Ruberg
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
- Section of Hematology and Medical Oncology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
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19
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Chowdhury RB, Leung N. How I Approach Light Chain Amyloidosis. G Ital Nefrol 2023; 40:2023-S81. [PMID: 38007836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Immunoglobulin Light Chain Amyloidosis (AL) is a progressive disease which leads to organ dysfunction and death. Tremendous progress has been made in staging, response, and treatment. The key to better survival though is early diagnosis which can be difficult since the symptoms are often nonspecific and can be seen in more common conditions. Once the diagnosis is confirmed, staging systems are available to provide prognosis on overall and renal survival. There are a number of treatments now available that are effective and well-tolerated. Response criteria have also been developed for hematologic and renal response in order to maximize response and minimize adverse effects. Newer therapies are being developed in particular anti-fibril therapies that are in clinical trials. For those patients who had a very good partial response or better, kidney transplantation may be an option if the kidney failure is not reversed.
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Affiliation(s)
- Raad B Chowdhury
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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20
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Iwamuro M, Tanaka S, Toyokawa T, Nishimura M, Tsuzuki T, Miyahara K, Negishi S, Ohya S, Tanaka T, Otsuka M. Endoscopic Manifestations and Clinical Characteristics of Localized Gastric Light-Chain Amyloidosis. Acta Med Okayama 2023; 77:545-552. [PMID: 37899266 DOI: 10.18926/amo/65978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
To determine the endoscopic and clinical features of localized gastric amyloid light-chain (AL) amyloidosis, we retrospectively examined the characteristics of nine patients (eight men and one woman) encountered by the hospitals in our network. Lesions were predominantly flat and depressed with surface vascular dilatation (n=5); others were characterized by subepithelial lesions (n=2), mucosal color change (n=1), and a mass-like morphology with swollen mucosal folds (n=1). Colonoscopy (n=7), video capsule enteroscopy (n=2), serum (n=5) and urine immunoelectrophoresis (n=4), and bone marrow examination (n=3) were performed to exclude involvement of organs other than the stomach. As treatment for gastric lesions of AL amyloidosis, one patient each underwent endoscopic submucosal dissection (n=1) and argon plasma coagulation (n=1), while the remaining seven patients underwent no specific treatment. During a mean follow-up of 4.2 years, one patient died 3.2 years after diagnosis, but the cause of death, which occurred in another hospital, was unknown. The remaining eight patients were alive at the last visit. In conclusion, although localized gastric AL amyloidosis can show various macroscopic features on esophagogastroduodenoscopy, flat, depressed lesions with vascular dilatation on the surface are predominant.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Shouichi Tanaka
- Department of Gastroenterology, National Hospital Organization Iwakuni Clinical Center
| | - Tatsuya Toyokawa
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center
| | | | - Takao Tsuzuki
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital
| | - Koji Miyahara
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital
| | - Shin Negishi
- Department of Gastroenterology, Kagawa Prefectural Central Hospital
| | | | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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De Michieli L, Sinigiani G, De Gaspari M, Branca A, Rizzo S, Basso C, Trentin L, Iliceto S, Perazzolo Marra M, Cipriani A, Berno T. Light-chain cardiac amyloidosis for the non-expert: pearls and pitfalls. Intern Emerg Med 2023; 18:1879-1886. [PMID: 37338717 PMCID: PMC10543940 DOI: 10.1007/s11739-023-03335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
Cardiac amyloidosis (CA) is an uncommon, progressive, and fatal disease; the two main forms that can affect the heart are transthyretin CA and light chain CA (AL-CA). AL-CA is a medical urgency for which a diagnostic delay can be catastrophic for patients' outcome. In this manuscript, we focus on the pearls and pitfalls that are relevant to achieve a correct diagnosis and to avoid diagnostic and therapeutical delays. Through the aid of three unfortunate clinical cases, some fundamental diagnostic aspects are addressed, including the following: first, a negative bone scintigraphy does not exclude CA, with patients with AL-CA frequently showing no or mild cardiac uptake, and its execution should not delay hematological tests; second, fat pad biopsy does not have a 100% sensitivity for AL amyloidosis and, if negative, further investigations should be performed, particularly if the pre-test probability is high. Third, Congo Red staining is not sufficient to reach a definitive diagnosis and amyloid fibrils typing with mass spectrometry, immunohistochemistry, or immunoelectron microscopy is crucial. To achieve a timely and correct diagnosis, all the necessary investigations must be performed, always considering the yield and diagnostic accuracy of each examination.
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Affiliation(s)
- Laura De Michieli
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Giulio Sinigiani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Monica De Gaspari
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
- Cardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Antonio Branca
- Hematology and Clinical Immunology Branch, Department of Medicine, University of Padova, Padua, Italy
| | - Stefania Rizzo
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
- Cardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
- Cardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Branch, Department of Medicine, University of Padova, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
- Cardiology Unit, University Hospital of Padua, Padua, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
- Cardiology Unit, University Hospital of Padua, Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
- Cardiology Unit, University Hospital of Padua, Padua, Italy
| | - Tamara Berno
- Hematology and Clinical Immunology Branch, Department of Medicine, University of Padova, Padua, Italy
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22
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Oli SS, Jha A, Karki A, Sapkota S, Adhikari L. Primary Systemic Amyloidosis: A Case Report. JNMA J Nepal Med Assoc 2023; 61:822-824. [PMID: 38289775 PMCID: PMC10579773 DOI: 10.31729/jnma.8297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 02/01/2024] Open
Abstract
Primary systemic amyloidosis is a systemic disease characterised by the deposition of misfolded proteins extracellularly in different organs without any known cause in the background, eventually leading to multiorgan dysfunction and death. The incidence of primary amyloidosis is estimated at 5.1-12.8 cases per million, with a poor prognosis. We report a case of a 69-year male with lower back pain, shortness of breath, and anasarca diagnosed as primary systemic amyloidosis by serum-free light chain assay and kidney needle biopsy. He was started on intravenous bortezomib and dexamethasone. Though he adhered to his medications, with time he developed renal insufficiency marked by azotemia following which hemodialysis was performed. Primary systemic amyloidosis is a rare clinical condition with a very poor prognosis. Further studies are needed to understand the proper pathophysiology and treatment of the disease. Keywords cardiomyopathies; case reports; primary amyloidosis.
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Affiliation(s)
- Saurav Sen Oli
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Abhishek Jha
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Anisha Karki
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Shova Sapkota
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Laxman Adhikari
- Department of Nephrology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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23
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D’Souza A, Szabo A, Akinola I, Finkel M, Flynn KE. Differences in patient-reported outcomes (PROs) by disease severity in light chain (AL) amyloidosis. Eur J Haematol 2023; 111:536-543. [PMID: 37401100 PMCID: PMC10530507 DOI: 10.1111/ejh.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To assess the impact of organ involvement on patient-reported outcomes (PROs) in light chain (AL) amyloidosis. METHODS PROs were evaluated using the KCCQ-12, PROMIS-29 + 2, and SF-36 in individuals with AL amyloidosis. The 2004 Mayo system was used to stage disease and cardiac, neurologic, and renal involvement was considered. Global physical and mental health (MH) scores, physical function (PF), fatigue, social function (SF), pain, sleep, and MH domains were evaluated. Effect sizes between scores were measured using Cohen's d. RESULTS Of 297 respondents, the median age at diagnosis was 60 years with 58% cardiac, 58% renal, and 30% neurologic involvement. Fatigue, PF, SF, and global physical health with PROMIS and SF-36 discriminated the most by stage. Significant discrimination in PROMIS and/or SF-36 was seen in PF, fatigue, and global physical health with cardiac involvement. For neurologic involvement, PF, fatigue, SF, pain, sleep, global physical, and MH with PROMIS and role physical, vitality, pain, general health, and physical component summary with SF-36 were discriminatory. For renal amyloid, pain by SF-36 and PROMIS, and SF-36 MH and role emotional subscales were significant. CONCLUSIONS Fatigue, PF, SF, and global physical health can discriminate stage, cardiac and neurologic, but not renal, AL amyloidosis involvement.
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Affiliation(s)
- Anita D’Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin
| | - Idayat Akinola
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin
| | | | - Kathryn E Flynn
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin
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24
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Bnaya A, Tvito A, Ben-Chetrit E, Shavit L, Breuer GS. An unusual case of AL amyloidosis presenting as alopecia and nail changes. Intern Emerg Med 2023; 18:2133-2134. [PMID: 37086347 DOI: 10.1007/s11739-023-03284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Affiliated With the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel.
| | - Ariella Tvito
- Department of Hematology, Shaare Zedek Medical Center,, Affiliated With the Hebrew University, Jerusalem, Israel
| | - Eli Ben-Chetrit
- Infectious Diseases Unit, Shaare Zedek Medical Center, Affiliated With the Hebrew University, Jerusalem, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Affiliated With the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel
| | - Gabriel Simon Breuer
- Rheumatology Unit, Shaare Zedek Medical Center, Affiliated With the Hebrew University, Jerusalem, Israel
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Pegat A, Bernard E. Immunoglobulin light-chain amyloidosis mimicking bulbar amyotrophic lateral sclerosis. Amyloid 2023; 30:346-347. [PMID: 37294189 DOI: 10.1080/13506129.2022.2163891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/26/2022] [Indexed: 06/10/2023]
Affiliation(s)
- Antoine Pegat
- Centre SLA de Lyon, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, 59 boulevard Pinel, Bron, 69677, France
- Service ENMG et pathologies neuromusculaires, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, Bron, France
- Institut NeuroMyoGène, Université Lyon1 - CNRS UMR 5310 - INSERM U1217, Lyon, France
| | - Emilien Bernard
- Centre SLA de Lyon, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, 59 boulevard Pinel, Bron, 69677, France
- Service ENMG et pathologies neuromusculaires, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, Bron, France
- Institut NeuroMyoGène, Université Lyon1 - CNRS UMR 5310 - INSERM U1217, Lyon, France
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Silvert E, Hester L, Ramudu E, Pawlowski C, Kranenburg B, Buadi F, Muchtar E, Khaled S, Tran N, Soundararajan V, Khan N, Gertz M, Dispenzieri A. Identifying signs and symptoms of AL amyloidosis in electronic health records using natural language processing, diagnosis codes, and manually abstracted registry data. Am J Hematol 2023; 98:E255-E258. [PMID: 37403432 DOI: 10.1002/ajh.27019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Affiliation(s)
| | - Laura Hester
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | | | | | | | - Francis Buadi
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eli Muchtar
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samer Khaled
- Janssen Research & Development, LLC, Los Angeles, California, USA
| | - Namphuong Tran
- Janssen Research & Development, LLC, Los Angeles, California, USA
| | | | - Najat Khan
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Morie Gertz
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Angela Dispenzieri
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Hegenbart U, Aus dem Siepen F, Schönland S. [Light chain amyloidosis]. Inn Med (Heidelb) 2023; 64:842-847. [PMID: 37540260 DOI: 10.1007/s00108-023-01568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/05/2023]
Abstract
Light chain amyloidosis (AL) is a rare protein deposition disease. It is caused by a clonal plasma cell or B‑cell disease in the bone marrow. With the exception of the central nervous system, all organs can be affected by amyloid deposits. Cardiac involvement is the most frequent organ manifestation that leads to significantly increased mortality when it is diagnosed at an advanced stage. The causal treatment of AL amyloidosis is reduction of amyloidogenic light chains by chemotherapy. Early diagnosis of the disease is essential to reduce early mortality, to effectively treat patients and to prevent further deterioration of organ function. New treatment approaches for AL amyloidosis are aimed at inhibiting amyloid formation or degradation of amyloid in organs.
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Affiliation(s)
- Ute Hegenbart
- Amyloidose-Zentrum, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
| | - Fabian Aus dem Siepen
- Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Stefan Schönland
- Amyloidose-Zentrum, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
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Chaltsev BD, Torgashina AV. [AL amyloidosis mimicking IgG4-related disease: case report]. TERAPEVT ARKH 2023; 95:425-428. [PMID: 38158996 DOI: 10.26442/00403660.2023.05.202198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 01/03/2024]
Abstract
The article describes a unique clinical case of AL amyloidosis mimicking IgG4-related disease. Plasma cell dyscrasias can mimic clinical and laboratory manifestations of rheumatic diseases, which can lead to a delay in diagnosis and inappropriate therapy.
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Chitimus DM, Berling E, Garderet L, Venturelli N, Malfatti E, Authier FJ, Nicolas G, Laforêt P, Lefeuvre C. Systemic light chain amyloidosis myopathy responsive to daratumumab monotherapy. Eur J Neurol 2023; 30:745-748. [PMID: 36403110 PMCID: PMC10098764 DOI: 10.1111/ene.15640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/09/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE Amyloid myopathy is a rare and severe manifestation of systemic light chain (AL) amyloidosis. Early diagnosis and staging are mandatory for optimal therapy, given the rapid progression of muscle weakness. Despite the efficacy of bortezomib-based treatment regimens, there is a lack of therapeutic alternatives in non-responsive patients. METHOD The case report of a patient with systemic AL amyloidosis myopathy treated with daratumumab is presented. RESULTS A 70-year-old man displayed severe proximal muscle weakness which had developed over a 10-month period. Blood tests revealed an immunoglobulin A lambda monoclonal gammopathy, whilst muscle biopsy showed amyloid deposits within the arteriolar walls, confirming the diagnosis of amyloid myopathy associated with AL amyloidosis. Initial treatment with a bortezomib-based regimen showed no clinical or hematological improvement. After switching to daratumumab monotherapy, our patient achieved a favorable evolution with respect to functional muscle scoring and a complete hematological response. CONCLUSION To our knowledge, this is the first case report of an amyloid myopathy showing a remarkable clinical improvement in response to daratumumab monotherapy. It thereby highlights the potential of daratumumab as a monotherapeutical approach to the treatment of amyloid myopathy complicating AL amyloidosis.
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Affiliation(s)
- Diana Maria Chitimus
- Neurology Department, Raymond Poincaré University Hospital, APHP, Garches, France
| | - Edouard Berling
- Neurology Department, Raymond Poincaré University Hospital, APHP, Garches, France
- Nord-Est-Ile-de-France Neuromuscular Reference Center, FHU PHENIX, Garches, France
- U 1179 INSERM, Université Paris-Saclay, Montigny-le-Bretonneux, France
| | - Laurent Garderet
- Haematology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Nadia Venturelli
- Diagnostic and Interventional Medical Imaging Department, Raymond Poincaré Hospital, Garches, France
- DMU Smart Imaging, GH Université Paris-Saclay, APHP, Garches, France
| | - Edoardo Malfatti
- Nord-Est-Ile-de-France Neuromuscular Reference Center, FHU PHENIX, Garches, France
- U955 INSERM, EnvA, EFS, IMRB, Université Paris Est, Créteil, France
- Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, APHP, Henri Mondor Hospital, Créteil, France
| | - François Jérôme Authier
- Nord-Est-Ile-de-France Neuromuscular Reference Center, FHU PHENIX, Garches, France
- U955 INSERM, EnvA, EFS, IMRB, Université Paris Est, Créteil, France
- Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, APHP, Henri Mondor Hospital, Créteil, France
| | - Guillaume Nicolas
- Neurology Department, Raymond Poincaré University Hospital, APHP, Garches, France
- Nord-Est-Ile-de-France Neuromuscular Reference Center, FHU PHENIX, Garches, France
- U 1179 INSERM, Université Paris-Saclay, Montigny-le-Bretonneux, France
| | - Pascal Laforêt
- Neurology Department, Raymond Poincaré University Hospital, APHP, Garches, France
- Nord-Est-Ile-de-France Neuromuscular Reference Center, FHU PHENIX, Garches, France
- U 1179 INSERM, Université Paris-Saclay, Montigny-le-Bretonneux, France
| | - Claire Lefeuvre
- Neurology Department, Raymond Poincaré University Hospital, APHP, Garches, France
- Nord-Est-Ile-de-France Neuromuscular Reference Center, FHU PHENIX, Garches, France
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Merlini G, Sarosiek S, Benevolo G, Cao X, Dimopoulos M, Garcia-Sanz R, Gatt ME, Fernandez de Larrea C, San-Miguel J, Treon SP, Minnema MC. Report of Consensus Panel 6 from the 11 th International Workshop on Waldenström's Macroglobulinemia on Management of Waldenström's Macroglobulinemia Related Amyloidosis. Semin Hematol 2023; 60:113-117. [PMID: 37099030 DOI: 10.1053/j.seminhematol.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
Consensus Panel 6 (CP6) of the 11th International Workshop on Waldenström's Macroglobulinemia (IWWM-11) was tasked with reviewing the state of the art for diagnosis, prognosis, and therapy of AL amyloidosis associated with Waldenström macroglobulinemia (WM). Since significant advances have been made in the management of AL amyloidosis an update for this rare disease associated with WM was necessary. The key recommendations from IWWM-11 CP6 included: (1) The need to improve the diagnostic process by recognizing red flags and using biomarkers and imaging; (2) The essential tests for appropriate workup; (3) The diagnostic flowchart, including mandatory amyloid typing, that improves the differential diagnosis with transthyretin amyloidosis; (4) Criteria for therapy response assessment; (5) State of the art of the treatment including therapy of wild type transthyretin amyloidosis associated with WM.
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Affiliation(s)
- Giampaolo Merlini
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy.
| | - Shayna Sarosiek
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Giulia Benevolo
- SSD Mieloma Unit e Clinical Trial e S.C. Hematology U, Turin, Turin, Italy
| | - Xinxin Cao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, Beijing, China
| | - Meletios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ramon Garcia-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca, CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Salamanca, Spain
| | - Moshe E Gatt
- Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Jesus San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Navarra, Spain
| | - Steven P Treon
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, Utrecht, the Netherlands
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Bézard M, Kharoubi M, Galat A, Le Bras F, Poullot E, Molinier-Frenkel V, Fanen P, Funalot B, Moktefi A, Abulizi M, Deux JF, Lemonnier F, Guendouz S, Chalard C, Zaroui A, Itti E, Hittinger L, Teiger E, Oghina S, Damy T. Real-Life Evaluation of an Algorithm for the Diagnosis of Cardiac Amyloidosis. Mayo Clin Proc 2023; 98:48-59. [PMID: 36464537 DOI: 10.1016/j.mayocp.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/25/2022] [Accepted: 08/12/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To evaluate the real-life use of a modified Gillmore algorithm with a "one-stop-shop" approach, bone scintigraphy (BS), a monoclonal gammopathy test (GT), a salivary gland biopsy (SGB), and genetic testing performed at the same time for the diagnosis of cardiac amyloidosis at the French National Reference Centre for Cardiac Amyloidosis (Henri Mondor Hospital, Créteil, France). METHODS This retrospective cohort study included a total of 1222 patients with suspected amyloidosis who underwent BS and GT between June 2008 and May 2019. RESULTS Of 1222 patients, 349 had no cardiac uptake on BS and negative GT (BS-/GT-), 276 were BS-/GT positive (GT+), 420 patients were BS+/GT-, and 177 were BS+/GT+. Our one-stop-shop check-up enabled us to diagnose 892 (72.9%) patients; 330 (27.0%) patients required additional examinations, such as mass spectrometry and/or a cardiac biopsy. This subset notably included 112 patients with amyloid light chain amyloidosis. More than 64% of the patients with transthyretin amyloidosis or another type of amyloidosis were diagnosed during the one-stop shop visit. Sensitivity and specificity of BS for transthyretin amyloidosis diagnosis was 99% and 96%, respectively. For amyloid light chain diagnosis, sensitivity and specificity were 100% and 76%, respectively, for GT and 54% and 100%, respectively, for SGB. Of 910 transthyretin genetic tests, 205 (17%) detected mutations. CONCLUSION The results of our real-life cohort study confirmed the ability of a one-stop-shop approach with a modified Gillmore algorithm to diagnose cardiac amyloidosis and the interest of simultaneous testing for earlier diagnosis. The SGB has diagnostic value because it is easy, quick, and less invasive than a cardiac biopsy.
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Affiliation(s)
- Mélanie Bézard
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France.
| | - Mounira Kharoubi
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Arnault Galat
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Fabien Le Bras
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Lymphoid Malignancies, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Elsa Poullot
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Valérie Molinier-Frenkel
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Pascale Fanen
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Genetics Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Benoit Funalot
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Genetics Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Anissa Moktefi
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Mukedaisi Abulizi
- Nuclear Medicine Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Jean-François Deux
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Radiology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - François Lemonnier
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Lymphoid Malignancies, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Soulef Guendouz
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Coraline Chalard
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Amira Zaroui
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Itti
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Nuclear Medicine Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Luc Hittinger
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Teiger
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Silvia Oghina
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Clinical Investigation Centre, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
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Kreiniz N, Gertz MA. Bad players in AL amyloidosis in the current era of treatment. Expert Rev Hematol 2023; 16:33-49. [PMID: 36620914 PMCID: PMC9905376 DOI: 10.1080/17474086.2023.2166924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Systemic AL amyloidosis (ALA) is a clonal plasma cell (PC) disease characterized by deposition of amyloid fibrils in different organs and tissues. Traditionally, the prognosis of ALA is poor and is primarily defined by cardiac involvement. The modern prognostic models are based on cardiac markers and free light chain difference (dFLC). Cardiac biomarkers have low specificity and are dependent on renal function, volume status, and cardiac diseases other than ALA. New therapies significantly improved the prognosis of the disease. The advancements in technologies - cardiac echocardiography (ECHO) and cardiac MRI (CMR), as well as new biological markers, relying on cardiac injury, inflammation, endothelial damage, and clonal and non-clonal PC markers are promising. AREAS COVERED An update on the prognostic significance of cardiac ALA, number of involved organs, response to treatment, including minimal residual disease (MRD), ECHO, MRI, and new biological markers will be discussed. The literature search was done in PubMed and Google Scholar, and the most recent and relevant data are included. EXPERT OPINION Prospective multicenter trials, evaluating multiple clinical and laboratory parameters, should be done to improve the risk assessment models in ALA in the modern era of therapy.
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Affiliation(s)
- Natalia Kreiniz
- Division of Hematology, Bnai Zion Medical Centre, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Kwok CS, Moody WE. The importance of pathways to facilitate early diagnosis and treatment of patients with cardiac amyloidosis. Ther Adv Cardiovasc Dis 2023; 17:17539447231216318. [PMID: 38099406 PMCID: PMC10725150 DOI: 10.1177/17539447231216318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Cardiac amyloidosis (CA) is a condition caused by extracellular deposition of amyloid fibrils in the heart. It is an underdiagnosed disease entity which can present with a variety of cardiac and non-cardiac manifestations. Diagnosis usually follows an initial suspicion based on clinical evaluation or imaging findings before confirmation with subsequent imaging (echocardiography, cardiac magnetic resonance imaging, 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy) in combination with biochemical screening for monoclonal dyscrasia (serum free light chains and serum and urine electrophoresis) and/or histology (bone marrow trephine, fat or endomyocardial biopsy). More than 95% of CA can be classified as either amyloid light-chain (AL) CA or amyloid transthyretin (ATTR) CA; these two conditions have very different management strategies. AL-CA, which may be associated with multiple myeloma, can be managed with chemotherapy agents, autologous stem cell transplantation, cardiac transplant and supportive therapies. For ATTR-CA, there is increasing importance in making an early diagnosis because of novel treatments in development, which have transformed this once incurable disease to a potentially treatable disease. Timely diagnosis is crucial as there may only be a small window of opportunity where patients can benefit from treatment beyond which therapies may be less effective. Reviewing the existing patient pathway provides a basis to better understand the complexities of real-world activities which may be important to help reduce missed opportunities related to diagnosis and treatment for patients with CA. With healthcare provider interest in improving the care of patients with CA, the development of an optimal care pathway for the condition may help reduce delays in diagnosis and treatment and thus enhance patient outcomes.
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Affiliation(s)
- Chun Shing Kwok
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Newcastle Rd, Stoke-on-Trent ST4 6QG, UK
| | - William E. Moody
- Department of Cardiology, University Hospitals of Birmingham NHS Trust, Birmingham, UK
- Chun Shing Kwok is now affiliated to Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- William E. Moody is also affiliated to University of Birmingham, Birmingham, UK
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Turco S, Lazzari J, Manetti AC, Maiese A, Bugelli V, Emdin M, Aimo A, Di Paolo M. Death occurred due to undiagnosed systemic amyloidosis: a case report. Clin Ter 2022; 173:516-519. [PMID: 36373446 DOI: 10.7417/ct.2022.2473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Amyloidosis is a disorder related to errors in protein folding. We present a clinical case of systemic amyloidosis manifesting as hypotension, tachycardia, pain, weight loss, asthenia, anorexia, dysphagia, and mood deflection in a 49-year-old-year-old woman with a previous clinical history of articular and muscular pain, correlated to suspected seronegative arthritis. The blood test revealed kidney insufficiency, an electrocardiogram identified low voltages of the peripheral leads and T waves anomalies. A serum protein electrophoresis revealed the presence of high levels of monoclonal kappa free chains. The woman started to have a sense of suffocation, and after one week she was found dead in her bed. After the autopsy, the results of Congo red staining of the myocardium were characteristic of amyloid. According to the autoptic and the histological examination, death occurred due to acute cardiac and respiratory arrest secondary to amyloid cardiomyopathy in a patient with undiagnosed systemic amyloidosis.
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Affiliation(s)
- S Turco
- Department of Legal Medicine Azienda ULSS 2 Marca Trevigiana, Italy
| | - J Lazzari
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - A C Manetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - A Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - V Bugelli
- Azienda USL Toscana Sud-Est sede di Grosseto, Gros-seto, Italy
| | - M Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Aimo
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - M Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
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Posadas-Martinez ML, Aguirre MA, Brulc E, Saez MS, Sorroche P, Machnicki G, Fernandez M, Nucifora EM. Treatment patterns and outcomes in light chain amyloidosis: An institutional registry of amyloidosis report in Argentina. PLoS One 2022; 17:e0274578. [PMID: 36301970 PMCID: PMC9612475 DOI: 10.1371/journal.pone.0274578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 08/30/2022] [Indexed: 11/06/2022] Open
Abstract
Light chain (AL) amyloidosis is a form of systemic amyloidosis, causing organ dysfunction, mainly affecting the heart and kidney. Patient-tailored and risk-adapted decision making is critical in AL amyloidosis management. There is limited real-world evidence data from Argentina and Latin America regarding the treatment approaches for AL amyloidosis. This retrospective cohort study aimed to describe the treatment patterns and outcomes in adult patients (>18 years) diagnosed with AL amyloidosis at the Hospital Italiano in Buenos Aires, Argentina, using a 10-yearfollow-up data (June 1, 2010 to May 31, 2019) from the institutional registry of amyloidosis (IRA). The study population had a mean age of 63 years and 54.4% weremale. Heart and kidney were the most frequently affected organs. Of the 90 eligible patients included in the study, 70underwent treatment. Bortezomib-based regimen was the preferred first-line treatment (75.7% patients). Overall,54.4% of the patients presented a deep response (complete or very good partial response). Median overall survival (OS) was 5years, the 1-year OS and progression free survival rates were 80% (95% confidence interval [CI]: 68–87) and 80% (95%CI 68–87)), respectively. This study provides vital real-world evidence for the long-term treatment patterns and survival in a large cohort of AL amyloidosis patients in Argentina.
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Affiliation(s)
- Maria Lourdes Posadas-Martinez
- Internal Medicine Department, Internal Medicine Research Unit, CONICET, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- * E-mail:
| | - María Adela Aguirre
- Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Erika Brulc
- Internal Medicine Department, Hematology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maria Soledad Saez
- Internal Medicine Department, Biochemestry Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Patricia Sorroche
- Internal Medicine Department, Biochemestry Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Elsa Mercedes Nucifora
- Hematology Service, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Fedotov SA, Khrabrova MS, Anpilova AO, Dobronravov VA, Rubel AA. Noninvasive Diagnostics of Renal Amyloidosis: Current State and Perspectives. Int J Mol Sci 2022; 23:ijms232012662. [PMID: 36293523 PMCID: PMC9604123 DOI: 10.3390/ijms232012662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
Amyloidoses is a group of diseases characterized by the accumulation of abnormal proteins (called amyloids) in different organs and tissues. For systemic amyloidoses, the disease is related to increased levels and/or abnormal synthesis of certain proteins in the organism due to pathological processes, e.g., monoclonal gammopathy and chronic inflammation in rheumatic arthritis. Treatment of amyloidoses is focused on reducing amyloidogenic protein production and inhibition of its aggregation. Therapeutic approaches critically depend on the type of amyloidosis, which underlines the importance of early differential diagnostics. In fact, the most accurate diagnostics of amyloidosis and its type requires analysis of a biopsy specimen from the disease-affected organ. However, absence of specific symptoms of amyloidosis and the invasive nature of biomaterial sampling causes the late diagnostics of these diseases, which leads to a delayed treatment, and significantly reduces its efficacy and patient survival. The establishment of noninvasive diagnostic methods and discovery of specific amyloidosis markers are essential for disease detection and identification of its type at earlier stages, which enables timely and targeted treatment. This review focuses on current approaches to the diagnostics of amyloidoses, primarily with renal involvement, and research perspectives in order to design new specific tests for early diagnosis.
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Affiliation(s)
- Sergei A. Fedotov
- Laboratory of Amyloid Biology, St. Petersburg State University, St. Petersburg 199034, Russia
- Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg 199034, Russia
| | - Maria S. Khrabrova
- Laboratory of Amyloid Biology, St. Petersburg State University, St. Petersburg 199034, Russia
- Research Institute of Nephrology, Pavlov University, St. Petersburg 197101, Russia
| | - Anastasia O. Anpilova
- Laboratory of Amyloid Biology, St. Petersburg State University, St. Petersburg 199034, Russia
- Research Institute of Nephrology, Pavlov University, St. Petersburg 197101, Russia
| | | | - Aleksandr A. Rubel
- Laboratory of Amyloid Biology, St. Petersburg State University, St. Petersburg 199034, Russia
- Department of Genetics and Biotechnology, St. Petersburg State University, St. Petersburg 199034, Russia
- Correspondence: ; Tel.: +7-812-428-40-09
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Muñoz SG, Rosellón RJ, Sánchez JL, Larrea ME, Bellvís LM. Primary amyloidosis presenting with acute intestinal obstruction. An unusual case. J Gastrointestin Liver Dis 2022; 31:257-258. [PMID: 35694991 DOI: 10.15403/jgld-4336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Sonsoles Garrosa Muñoz
- General and Gastrointestinal Surgery Department. Hospital Universitario de Salamanca, Salamanca, Spain.
| | - Raquel Jiménez Rosellón
- General and Gastrointestinal Surgery Department. Hospital Universitario de Salamanca, Salamanca, Spain.
| | - Jaime López Sánchez
- General and Gastrointestinal Surgery Department. Hospital Universitario de Salamanca, Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL). Universidad de Salamanca, Salamanca, Spain.
| | - Marta Eguía Larrea
- General and Gastrointestinal Surgery Department. Hospital Universitario de Salamanca, Salamanca, Spain.
| | - Luis Muñoz Bellvís
- General and Gastrointestinal Surgery Department. Hospital Universitario de Salamanca, Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL). Universidad de Salamanca, Salamanca, Spain.
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Jain A. Comments on COVID-19 and AL Amyloidosis, the Missing Links. Am J Med 2022; 135:e137-e138. [PMID: 35623720 PMCID: PMC9127178 DOI: 10.1016/j.amjmed.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Ankur Jain
- Department of Haematology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
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Maurer MS, Dunnmon P, Fontana M, Quarta CC, Prasad K, Witteles RM, Rapezzi C, Signorovitch J, Lousada I, Merlini G. Proposed Cardiac End Points for Clinical Trials in Immunoglobulin Light Chain Amyloidosis: Report From the Amyloidosis Forum Cardiac Working Group. Circ Heart Fail 2022; 15:e009038. [PMID: 35331001 PMCID: PMC9202961 DOI: 10.1161/circheartfailure.121.009038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Immunoglobulin light chain amyloidosis is a rare, multisystemic, phenotypically heterogenous disease affecting cardiovascular, renal, neurological, and gastrointestinal systems to varying degrees. Its underlying cause is a plasma cell dyscrasia characterized by misfolding of monoclonal immunoglobulin light chains which leads to aggregation and deposition of insoluble amyloid fibrils in target organs. Prognosis is primarily dependent on extent of cardiac involvement and depth of hematologic response to treatment. To facilitate development of new therapies, a public-private partnership was formed between the nonprofit Amyloidosis Research Consortium and the US Food and Drug Administration Center for Drug Evaluation and Research. In 2020, the Amyloidosis Forum launched an initiative to identify novel/composite end points and analytic strategies to expedite clinical trials for development of new therapies for the primary hematologic disorder and organ system manifestations. Specialized working groups identified organ-specific end points; additional working groups reviewed health-related quality of life measures and statistical approaches to data analysis. Each working group comprised amyloidosis experts, patient representatives, statisticians, and representatives from the Food and Drug Administration, the UK Medicines and Healthcare Products Regulatory Agency, and pharmaceutical companies. This review summarizes the proceedings and recommendations of the Cardiac Working Group. Using a modified Delphi method, the group identified, reviewed, and prioritized cardiac end points relevant to immunoglobulin light chain amyloidosis in the context of an antiplasma cell therapy. Prioritized cardiovascular end points included overall survival, hospitalization, N-terminal pro-B-type natriuretic peptide level, 6-minute walk test, Kansas City Cardiac Questionnaire, and cardiac deterioration progression-free survival. These recommended components will be further explored through evaluation of clinical trial datasets and formal guidance from regulatory authorities.
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Affiliation(s)
- Mathew S. Maurer
- Columbia University Irving Medical Center‚ New York‚ NY (M.S.M.)
| | | | | | | | - Krishna Prasad
- UK Medicines and Healthcare Products Regulatory Agency‚ London (K.P.)
| | | | - Claudio Rapezzi
- University of Ferrara, Italy (C.R.)
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy (C.R.)
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Ehsan H, Rafae A, Masood A, Wahab A, Sana MK, Ansar I, Neupane K, Umar A, Ehsan A, Hashmi H. Efficacy and Safety of Daratumumab-based Regimens in Pretreated Light Chain (AL) Amyloidosis: A Systematic Review. Clin Lymphoma Myeloma Leuk 2022; 22:e285-e292. [PMID: 34879994 DOI: 10.1016/j.clml.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
With recent advances in novel chemotherapeutic agents and increasing use of autologous hematopoietic stem cell transplant, there has been a significant improvement in outcomes for patients with AL Amyloidosis. Daratumumab, with its excellent safety and efficacy profile, appears to be an ideal treatment option for patients with newly diagnosed as well as relapsed refractory AL amyloidosis. In this systematic review, we analyzed the published literature on the role of Daratumumab in pretreated relapsed and refractory AL-amyloidosis patients using PubMed, Embase, Cochrane, and clinicaltrials.gov databases. A total of 16 studies evaluated the role of Daratumumab as monotherapy (DMT) or in combination with other chemotherapeutic agents (DCT). DMT and DCT were associated with promising efficacy with hematologic and organ responses (cardiac/renal) seen in 50%-90% and 50%-80% of the patients, respectively. Daratumumab appeared to be well tolerated with no significant treatment-related adverse events as DMT or DCT.
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Affiliation(s)
- Hamid Ehsan
- Division of Hematology-Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC.
| | - Abdul Rafae
- Department of Internal Medicine, McLaren Flint-Michigan State University, Flint, MI
| | - Adeel Masood
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Ahsan Wahab
- Department of Internal Medicine, Baptist Medical Center South/University of Alabama at Birmingham, Montgomery, AL
| | - Muhammad Khawar Sana
- Department of Internal Medicine, John H Stroger Jr Hospital of Cook County, Chicago, IL
| | - Iqraa Ansar
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH
| | - Karun Neupane
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Arooj Umar
- Department of Internal Medicine, Western Reserve Health Education/NeoMed, Warren, OH
| | - Amrat Ehsan
- Department of Internal Medicine, MedStar Health, Baltimore, MD
| | - Hamza Hashmi
- Division of Hematology-Oncology, Medical University of South Carolina, Charleston, SC
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Ravichandran S, Law S, Mahmood S, Wisniowski B, Foard D, Fontana M, Martinez-Naharro A, Whelan C, Gillmore JD, Lachmann HJ, Hawkins PN, Wechalekar AD. Early relapse is an adverse prognostic marker in systemic immunoglobulin light chain (AL) Amyloidosis. Leukemia 2022; 36:1180-1184. [PMID: 34987193 PMCID: PMC8979816 DOI: 10.1038/s41375-021-01497-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/02/2021] [Accepted: 12/09/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Sriram Ravichandran
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Steven Law
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Shameem Mahmood
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Brenden Wisniowski
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Darren Foard
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Marianna Fontana
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Carol Whelan
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Helen J Lachmann
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK.
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Abstract
Amyloidosis is a disorder of protein misfolding and metabolism in which insoluble fibrils are deposited in various tissues, causing organ dysfunction and eventually death. Out of the 60-plus heterogeneous amyloidogenic proteins that have been identified, approximately 30 are associated with human disease. The unifying feature of these proteins is their tendency to form beta-pleated sheets aligned in an antiparallel fashion. These sheets then form rigid, nonbranching fibrils that resist proteolysis, causing mechanical disruption and local oxidative stress in affected organs such as the heart, liver, kidneys, nervous system, and gastrointestinal tract. Here we review the epidemiology of light chain amyloidosis, the staging, and the concomitant prognostication that is critical in determining the appropriate treatment.
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Abstract
Cardiac amyloidosis (CA) is a restrictive cardiomyopathy with a traditionally poor prognosis. Until recently, CA treatment options were limited and consisted predominantly of managing symptoms and disease-related complications. However, the last decade has seen significant advances in disease-modifying therapies, increased awareness of CA, and improved diagnostic methods resulting in earlier diagnoses. In this review, we provide an overview of current and experimental treatments for the predominant types of CA: transthyretin cardiac amyloidosis (ATTR-CA) and immunoglobulin light chain (AL)-mediated CA (AL-CA). The mainstay of AL-CA treatment is proteasome inhibitor-based chemotherapy with daratumumab and, when feasible, autologous stem cell transplantation. For ATTR-CA, the stabilizer tafamidis is the only US Food and Drug Administration (FDA)-approved treatment. However, promising novel therapies on the horizon target various points in the ATTR-CA amyloidogenic cascade. These include transthyretin gene (TTR) silencing agents to prevent TTR formation, TTR tetramer stabilization and inhibition of oligomer aggregation to prevent fibril formation, anti-TTR fiber antibodies, and amyloid degradation. For end-stage CA, advanced interventions may need to be considered, including heart, heart-kidney, and, for hereditary ATTR-CA, heart-liver transplantation. Despite the evolution of treatment options, CA management remains complex due to patient frailty and therapeutic side effects or intolerance with advanced cardiac disease. This is particularly relevant for those with AL-CA, when active teamwork between the hematologist-oncologist and the cardiologist is critical for treatment success. Often, referral to an expert center is necessary for timely diagnosis, initiation of treatment, and participation in clinical trials.
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Affiliation(s)
- Lily K. Stern
- Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, US
| | - Jignesh Patel
- Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, US
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Cohen OC, Ismael A, Pawarova B, Manwani R, Ravichandran S, Law S, Foard D, Petrie A, Ward S, Douglas B, Martinez-Naharro A, Chacko L, Quarta CC, Mahmood S, Sachchithanantham S, Lachmann HJ, Hawkins PN, Gillmore JD, Fontana M, Falk RH, Whelan CJ, Wechalekar AD. Longitudinal strain is an independent predictor of survival and response to therapy in patients with systemic AL amyloidosis. Eur Heart J 2022; 43:333-341. [PMID: 34472567 DOI: 10.1093/eurheartj/ehab507] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/29/2021] [Accepted: 08/05/2021] [Indexed: 01/28/2023] Open
Abstract
AIMS Cardiac involvement, a major determinant of prognosis in AL (light-chain immunoglobulin) amyloidosis, is characterized by an impairment of longitudinal strain (LS%). We sought to evaluate the utility of LS% in a prospectively observed series of patients. METHODS AND RESULTS A total of 915 serial newly diagnosed AL patients with comprehensive baseline assessments, inclusive of echocardiography, were included. A total of 628/915 (68.6%) patients had cardiac involvement. The LS% worsened with advancing cardiac stage with mean -21.1%, -17.1%, -12.9%, and -12.1% for stages I, II, IIIa, and IIIb, respectively (P < 0.0001). There was a highly significant worsening of overall survival (OS) with worsening LS% quartile: LS% ≤-16.2%: 80 months, -16.1% to -12.2%: 36 [95% confidence interval (CI) 20.9-51.1] months, -12.1% to -9.1%: 22 (95% CI 9.1-34.9) months, and ≥-9.0%: 5 (95% CI 3.2-6.8) months (P < 0.0001). Improvement in LS% was seen at 12 months in patients achieving a haematological complete response (CR) (median improvement from -13.8% to -14.9% in those with CR and difference between involved and uninvolved light chain <10 mg/L). Strain improvement was associated with improved OS (median not reached at 53 months vs. 72 months in patients without strain improvement, P = 0.007). Patients achieving an LS% improvement and a standard N-terminal pro-brain natriuretic peptide-based cardiac response survived longer than those achieving a biomarker-based cardiac response alone (P < 0.0001). CONCLUSION Baseline LS% is a functional marker that correlates with worsening cardiac involvement and is predictive of survival. Baseline LS% and an absolute improvement in LS% are useful additional measures of prognosis and response to therapy in cardiac AL amyloidosis, respectively.
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Affiliation(s)
- Oliver C Cohen
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Andreia Ismael
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Babita Pawarova
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Richa Manwani
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Sriram Ravichandran
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Steven Law
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Darren Foard
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Aviva Petrie
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Sevda Ward
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Brooke Douglas
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Liza Chacko
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | | | - Shameem Mahmood
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | | | - Helen J Lachmann
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Rodney H Falk
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Carol J Whelan
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
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Jurczyszyn A, Rajtar-Salwa R, Sorysz D, Zawiślak B, Suska A, Szostek M. Reversing the poor prognosis of primary light-chain amyloidosis with cardiac involvement. Pol Arch Intern Med 2022; 132. [PMID: 35076194 DOI: 10.20452/pamw.16197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Artur Jurczyszyn
- Plasma Cell Dyscrasias Center, Department of Hematology, Jagiellonian University Medical College, Kraków, Poland.
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Danuta Sorysz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Barbara Zawiślak
- Intensive Cardiac Care Unit, University Hospital, Kraków, Poland
| | - Anna Suska
- Plasma Cell Dyscrasias Center, Department of Hematology, Jagiellonian University Medical College, Kraków, Poland
| | - Marta Szostek
- Department of Hematology, Jagiellonian University Medical College, Kraków, Poland
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Muniyan S, Nair Sreela LS, Mathew P, Prasad T, Nair AS, Jose M. Macroglossia Associated With Primary Systemic Amyloidosis - Case Report With Unusual Clinical Presentation. J Ayub Med Coll Abbottabad 2022; 34:197-199. [PMID: 35466653 DOI: 10.55519/jamc-01-9317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Amyloidosis is characterised by the deposition of fibrillar insoluble proteinaceous material called amyloid in the extracellular spaces. It may present as localized form which is rare and systemic form. Systemic amyloidosis involves many organs like kidney, heart and liver. Manifestations of both types may vary based on the age of onset, degree and extension of the deposition. Understandably, the diagnosis is challenging but the early identification of the condition and the type of amyloidosis can increase the efficiency of treatment. Positive Congo red staining is the gold standard for demonstration of amyloid in tissue sections. Here we are presenting a case of a 77-year-old female patient who presented with the complaint of difficulty in swallowing for 2 years due to bilateral symmetrical enlargement of the tongue which was subsequently diagnosed as systemic amyloidosis.
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Affiliation(s)
- Suriyakala Muniyan
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Kerala, India
| | | | - Philips Mathew
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Kerala, India
| | - Twinkle Prasad
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Kerala, India
| | - Admaja Sreekantan Nair
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Kerala, India
| | - Merrin Jose
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Kerala, India
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Ishimitsu A, Tojo A, Hirao J, Yokoyama S, Ohira T, Murayama Y, Ishimitsu T, Kang D, Honda K, Ehara T, Ishida K, Ueda Y. AL-Kappa Primary Amyloidosis with Apolipoprotein A-IV Deposition. Intern Med 2022; 61:871-876. [PMID: 35296622 PMCID: PMC8987257 DOI: 10.2169/internalmedicine.7955-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 70-year-old woman with complaints of edema, general malaise, and hypotension was diagnosed with renal amyloidosis, and laser microdissection mass spectrometry revealed her amyloidosis to predominantly comprise the apolipoprotein A-IV type. The M-protein turned from negative to positive during the course, and a bone marrow biopsy showed smoldering myeloma. Treatment with bortezomib and dexamethasone failed to save her from heart failure six months after the onset. Western blotting of urine samples at the time of the renal biopsy showed that amyloid light-chain κ amyloidosis had been present since the onset. Unlike the myeloma, Congo red staining was positive in the plasma cells of the bone marrow.
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Affiliation(s)
- Akira Ishimitsu
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | - Akihiro Tojo
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | - Jun Hirao
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | - Shohei Yokoyama
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | - Takehiro Ohira
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | - Yoshiki Murayama
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | | | - Dedong Kang
- Department of Anatomy, Showa University School of Medicine, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University School of Medicine, Japan
| | - Takashi Ehara
- Department of Pathology, Shinshu University School of Medicine, Japan
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, Japan
| | - Yoshihiko Ueda
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Japan
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Affiliation(s)
- Shinichi Mizuno
- Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Japan
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Draghici M, Jercan A, Badelita SN, Irimia RM, Bastian AE, Dobrea C, Popescu M, Coriu D. Muscle involvement with pseudohypertrophy in systemic light chain amyloidosis: Case report. Medicine (Baltimore) 2021; 100:e28267. [PMID: 34941106 PMCID: PMC8702120 DOI: 10.1097/md.0000000000028267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Muscle pseudohypertrophy is a rare manifestation of light chain amyloidosis (AL) amyloidosis. PATIENT CONCERNS A 63-year-old woman presented with a 2-year history of progressive asthenia, macroglossia, dysphonia, cachexia, hypotension, paresthesia, and lower limb muscle hypertrophy. DIAGNOSIS Free serum lambda light chains were increased, and fat pad biopsy demonstrated Congo red-positive deposits. Additionally, electromyography showed a myopathic pattern, whereas muscle biopsy revealed amyloid deposits. A diagnosis of λAL with cardiac, renal, nervous system, and skeletal muscle involvement was established. INTERVENTIONS AND OUTCOMES The patient received 3 subsequent lines of therapy over the following 23 months, with very slow hematological remission followed by resolution of organ dysfunction. LESSONS Despite its rarity, muscle involvement should be considered in patients diagnosed with AL amyloidosis associated with unexplained muscle hypertrophy or weakness associated with macroglossia or elevated troponin T levels in the absence of clear cardiac involvement.
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Affiliation(s)
- Mirela Draghici
- Fundeni Clinical Institute, Bucharest, Romania
- “Carol Davila”University of Medicine and Pharmacy, Bucharest, Romania
| | - Andreea Jercan
- Fundeni Clinical Institute, Bucharest, Romania
- “Carol Davila”University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Ruxandra Maria Irimia
- Fundeni Clinical Institute, Bucharest, Romania
- “Carol Davila”University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandra Eugenia Bastian
- “Carol Davila”University of Medicine and Pharmacy, Bucharest, Romania
- Colentina Clinical Hospital, Bucharest, Romania
| | - Camelia Dobrea
- Fundeni Clinical Institute, Bucharest, Romania
- “Carol Davila”University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Daniel Coriu
- Fundeni Clinical Institute, Bucharest, Romania
- “Carol Davila”University of Medicine and Pharmacy, Bucharest, Romania
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Abstract
Systemic light chain (AL) amyloidosis is a protein misfolding disorder characterized by the deposition of abnormal immunoglobulin light chains in fibrillary aggregates, resulting in end-organ damage. Several unique challenges face treating physicians, including delayed diagnosis, advanced vital organ involvement, and morbidity with treatment. Aggressive supportive care and risk-adapted application of plasma cell-directed therapies are the cornerstones of management. The therapeutic revolution in multiple myeloma will likely further expand the arsenal against plasma cells. Careful investigation of these agents will be critical to establish their role in this fragile population. The promise of fibril-directed therapies to restore organ function remains despite early disappointments. In this review, we discuss new therapies to tackle AL amyloidosis using a case-based approach.
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Affiliation(s)
- Susan Bal
- Division of Hematology and Oncology, Department of Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Heather Landau
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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