Evaluation of intensive chemotherapy in AL amyloidosis: usefulness of flow cytometric analysis of plasma cells in bone marrow.
To investigate whether monoclonal plasma cells in the bone marrow are useful as a therapeutic marker in AL amyloidosis, serial flow cytometry was performed in five patients with this disorder before and after chemotherapy. Four patients were treated with 2 or 3 courses of VAD (vincristine, doxorubicin and dexamethazone) and subsequently with high-dose melphalan followed by auto-PBSCT. The remaining one patient was treated with two courses of VAD alone. Before treatment all patients exhibited a CD19- CD56+ subpopulation, which indicated monoclonal plasma cells, in varying degrees. After treatment all patients showed a decrease in monoclonal plasma cells in accordance with the disappearance of M-protein in serum and/or urine. In two patients treated with VAD followed by auto-PBSCT, polyclonal (CD19+ CD56-) and total plasma cells gradually increased in the follow-up study, while monoclonal plasma cells stayed at less than 0.3% nine months after treatment. No apparent correlation was found between altered maturation of plasma cells and disappearance of M-protein. With respect to easy detection of monoclonal plasma cells producing amyloidogenic M-protein, flow cytometry of bone marrow aspirates is useful and reliable in the follow-up of patients with AL amyloidosis and in the evaluation of the effects of chemotherapy.
Matsuda
Masayuki
M
Third Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto. matsuda@hsp.md.shinshu-u.ac.jp
Gono
Takahisa
T
Shimojima
Yasuhiro
Y
Sakashita
Kazuo
K
Koike
Kenichi
K
Ikeda
Shu-ichi
S
D000368:Aged; D000686:Amyloidosis / Q000175:diagnosis* / Q000628:therapy*; D015703:Antigens, CD / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001853:Bone Marrow / Q000276:immunology / Q000473:pathology*; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000627:therapeutic use*; D004317:Doxorubicin / Q000627:therapeutic use*; D005260:Female; D005434:Flow Cytometry; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009194:Myeloma Proteins / Q000032:analysis; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology*; D014750:Vincristine / Q000627:therapeutic use*
D015703:Antigens, CD; D009194:Myeloma Proteins; C085016:multiple myeloma M-proteins; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D008558:Melphalan