title: No regression of renal AL amyloid in monoclonal gammopathy after successful autologous blood stem cell transplantation and significant clinical improvement.
abstract: BACKGROUND
  High-dose chemotherapy followed by autologous blood stem cell transplantation induces remission of plasma cell dyscrasia in patients with AL amyloidosis. The impact of this treatment on the glomerular amyloid mass is still unknown.
  
  
  METHODS
  In the present study, the quantity of the renal amyloid mass before and more than 3 years after high-dose melphalan treatment and autologous blood stem cell transplantation was assessed in two patients. At the time of the second renal biopsy, both patients were in complete remission without detectable serum and urinary monoclonal IgA-lambda and a normal percentage of plasma cells in the bone marrow.
  
  
  RESULTS
  In both patients with biopsy-proven AL amyloidosis, urinary protein excretion decreased from 7 g/24 h to <2 g/24 h more than 3 years after autologous blood stem cell transplantation. In contrast, glomerular amyloid deposits persisted, as shown in the second biopsy.
  
  
  CONCLUSIONS
  Despite complete remission of the plasma cell dyscrasia and improvement of glomerular permeability, the amount of glomerular amyloid mass did not regress.
authors: Department of Medicine/Nephrology, University of Heidelberg, Bergheimerstrasse 56a, D-69115 Heidelberg, Germany. martin_zeier@med.uni-heidelberg.de
authors: Martin
authors: M
authors: Zeier
authors: Jolanta
authors: J
authors: Perz
authors: Reinhold P
authors: RP
authors: Linke
authors: Ugo
authors: U
authors: Donini
authors: Rüdiger
authors: R
authors: Waldherr
authors: Konrad
authors: K
authors: Andrassy
authors: Anthony D
authors: AD
authors: Ho
authors: Hartmut
authors: H
authors: Goldschmidt
mesh_terms: D000682:Amyloid / Q000032:analysis*; D000686:Amyloidosis / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007674:Kidney Diseases / Q000276:immunology / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D010265:Paraproteinemias / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D012074:Remission Induction; D014182:Transplantation, Autologous
chemical_list: D000682:Amyloid; D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan