[Long-term survival after autologous peripheral blood stem cell transplantation in a patient with primary AL amyloidosis complicating congestive heart failure].
A 44-year-old man was admitted to hospital because of respiratory distress and progressive edema in the lower extremities. He was diagnosed as having congestive heart failure, but his condition improved following intensive care. Echocardiogram revealed a thickened interventricular septum, insufficient diastolic function, and granular sparkling pattern in the ventricular wall. Pathological examination of a myocardial biopsy specimen showed the deposition of AL amyloid, resulting in a diagnosis of AL amyloidosis. He was then referred to our hospital for treatment. After a course of high-dose dexamethasone therapy, peripheral blood stem cells induced by the administration of granulocyte colony stimulating factor were harvested. He then received high-dose melphalan (HDM) with autologous peripheral blood stem cell transplantation (auto-PBSCT) support, leading to complete remission. He has been well for more than three years after the transplantation and enjoys the same daily life as before the onset of symptoms. HDM/auto-PBSCT for AL amyloidosis confers a higher response rate and longer survival than conventional chemotherapies; however, treatment-related toxicity is also high. Refinements of treatment strategies are urgently needed. This case provides insights into appropriate strategies for HDM/auto-PBSCT for AL amyloidosis with regard to patient selection, the best induction therapy, and the risk-adjusted melphalan conditioning dose; all of which should be confirmed by randomized controlled trials.
Saito
Mayuko
M
First Department of Internal Medicine, Sapporo Medical University School of Medicine.
Hayashi
Toshiaki
T
Nojima
Masahiro
M
Ikeda
Hiroshi
H
Tarasawa
Isao
I
Yasui
Hiroshi
H
Ishida
Tadao
T
Adachi
Masaaki
M
Imai
Kohzoh
K
Shinomura
Yasuhisa
Y
D000328:Adult; D000686:Amyloidosis / Q000150:complications / Q000628:therapy*; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation; D012074:Remission Induction; D014182:Transplantation, Autologous