Multiple myeloma-associated AL amyloidosis: is a distinctive therapeutic approach warranted?

被引:92
作者
Bahlis, N. J.
Lazarus, H. M.
机构
[1] Univ Calgary, Tom Baker Canc Ctr, Dept Med, Calgary, AB T2N 4N1, Canada
[2] Case Western Reserve Univ, Ctr Comprehens Canc, Cleveland, OH USA
[3] Univ Hosp Cleveland, Cleveland, OH USA
关键词
multiple myeloma; amyloidosis; transplant;
D O I
10.1038/sj.bmt.1705395
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
The natural history of multiple myeloma ( MM) was revolutionized by the introduction of haematopoietic stem cell transplantation to the treatment armamentarium of this disease. Defined subgroups of MM patients ( such as the elderly or dialysis-dependent) have required an individualized approach in order to minimize the transplant-related mortality. Little, however, is known about the management of 12 - 30% of MM patients with coexistent AL amyloidosis as the amyloidopathy is often overlooked and when recognized these patients commonly are excluded from clinical trials. While occult amyloidosis appears to have no impact on the toxicity and outcome of MM patients, the presence of symptomatic amyloidopathy clearly worsens their prognosis. Use of induction chemotherapy drugs that can cause further damage to the heart ( Adriamycin), nervous system ( Vincristine) or kidneys should be avoided as should lengthy delays in proceeding to autograft. Further, re. ning the transplant eligibility criteria for this subgroup of patients with coexistent amyloidopathy to include the number of organs involved and the degree of cardiac involvement ( NYHA class, Troponins and NT-pro-BNP levels) along with melphalan dose-adjustment will minimize the treatment-related toxicity and mortality and possibly allow a reversal of the organ damage induced by the amyloidogenic light chain.
引用
收藏
页码:7 / 15
页数:9
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