Primary amyloidosis associated with multiple myeloma. Predictors of successful therapy

The treatment of nephrotic syndrome caused by primary (light chain) amyloid with vincristine, doxorubicin and dexamethasone

“…Patients whose disease responds to treatment have a 5-year survival of 50-78%, although the median survival of the whole population is 12-28 months (Kyle and Greipp, 1983;Kyle et al, 1985Kyle et al, , 1997Fielder and Durie, 1986;Skinner et al, 1996).…”

“…Combination chemotherapy for AL amyloidosis has been used less widely, mainly because of poor performance status and perceived unsuitability of patients for such treatments, and it is often used after melphalan resistance has occurred (Case et al, 1977;Fielder and Durie, 1986;Levy et al, 1988). As vincristine, doxorubicin and dexamethasone (VAD) chemotherapy is considerably more effective when used at presentation of multiple myeloma than as salvage (Anderson et al, 1995), we were prompted to evaluate this regimen for first-line therapy in primary light chain amyloid (AL).…”

Nail Dystrophy

“…Features that maypredict respon¬ sive disease include no cardiac involvement, high ß2-microglobulin, and a K-type monoclonal protein. 10 Nail Dystrophy…”

Current Therapies for Light‐Chain Amyloidosis

“…The earliest reports of patient factors that predicted lack of response to melphalan and prednisone were cardiac involvement, lambda light-chain restriction, and low b 2 microglobulin [37]. Serum creatinine levels over 3 mg/ dL had also been associated with low organ response rates and poorer overall survival [38].…”