No regression of renal AL amyloid in monoclonal gammopathy after successful autologous blood stem cell transplantation and significant clinical improvement.
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.
Zeier
Martin
M
Department of Medicine/Nephrology, University of Heidelberg, Bergheimerstrasse 56a, D-69115 Heidelberg, Germany. martin_zeier@med.uni-heidelberg.de
Perz
Jolanta
J
Linke
Reinhold P
RP
Donini
Ugo
U
Waldherr
Rüdiger
R
Andrassy
Konrad
K
Ho
Anthony D
AD
Goldschmidt
Hartmut
H
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
D000682:Amyloid; D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan