title: Treatment of diuretic refractory pleural effusions with bevacizumab in four patients with primary systemic amyloidosis.
abstract: Refractory pleural effusions present a challenging management problem and are associated with a poor prognosis in patients with primary systemic amyloidosis (AL). We report a series of four patients with AL who presented with bilateral pleural effusions that were refractory to diuretic therapy. After treatment with bevacizumab, an antivascular endothelial growth factor (VEGF) antibody, three of the four patients had improvement in their pleural effusions, peripheral edema, and functional status. Additional studies are needed to further define the role of bevacizumab in the management of this group of patients.
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hoyer
authors.forename: Nelson
authors.initials: N
authors.lastname: Leung
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
mesh_terms: D000686:Amyloidosis / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D002216:Captopril / Q000627:therapeutic use; D015505:Chest Tubes; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004351:Drug Resistance; D004487:Edema / Q000188:drug therapy / Q000209:etiology; D017809:Fatal Outcome; D005665:Furosemide / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D034141:Hypoalbuminemia / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008788:Metolazone / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications; D009404:Nephrotic Syndrome / Q000209:etiology; D036102:Peripheral Blood Stem Cell Transplantation; D010996:Pleural Effusion / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D011239:Prednisolone / Q000627:therapeutic use; D012709:Serum Albumin / Q000627:therapeutic use; D013148:Spironolactone / Q000627:therapeutic use; D013792:Thalidomide / Q000627:therapeutic use; D013907:Thoracostomy; D014182:Transplantation, Autologous; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D004232:Diuretics; D012709:Serum Albumin; D042461:Vascular Endothelial Growth Factor A; D013148:Spironolactone; D000068258:Bevacizumab; D013792:Thalidomide; D005665:Furosemide; D003907:Dexamethasone; D002216:Captopril; D011239:Prednisolone; D008558:Melphalan; D008788:Metolazone