title: Successful treatment of primary AL amyloidosis by VAD therapy, high-dose melphalan, and autologous peripheral stem cell transplantation.
abstract: We report a 58-year-old Japanese man with primary systemic AL amyloidosis who achieved disappearance of proteinuria including Bence-Jones protein (lambda-type) after two courses of VAD therapy (vincristine, doxorubicin, and dexamethasone) and subsequent high-dose melphalan, followed by autologous peripheral blood stem cell transplantation. Because this patient did not have any apparent amyloidosis-related heart or liver damage and met all of the eligibility criteria for this therapy, this treatment was performed. Both proteinuria and M-protein disappeared completely, and he is doing well clinically at 19 months after treatment. However, amyloid deposits were still found in the kidneys, including the glomeruli and tubulointerstitium, when renal biopsy was done at 8 months after treatment. In the future, we may reach a time when clinical remission corresponds to histological remission.
authors.affiliation: Nephrology Center, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yamazaki
authors.affiliation: Nephrology Center, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan. ubara@toranomon.gr.jp.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.affiliation: Nephrology Center, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.affiliation: Nephrology Center, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Nakanishi
authors.affiliation: Nephrology Center, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.affiliation: Nephrology Center, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.affiliation: Nephrology Center, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Hayami
authors.affiliation: Nephrology Center, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamanouchi
authors.affiliation: Nephrology Center, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
authors.forename: Fumi
authors.initials: F
authors.lastname: Takemoto
authors.affiliation: Nephrology Center, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
authors.forename: Takaichi
authors.initials: T
authors.lastname: Kenmei
authors.affiliation: Department of Hematology, Toranomon Hospital, Kajigaya, Kawasaki, Kanagawa, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Masuoka
authors.affiliation: Department of Pathology, Toranomon Hospital, Kajigaya, Kawasaki, Kanagawa, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Oohashi
mesh_terms: D000686:Amyloidosis / Q000473:pathology / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols; D003907:Dexamethasone; D004317:Doxorubicin; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000473:pathology; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D014750:Vincristine
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D008558:Melphalan