Resolution of Primary Amyloidosis During Chemotherapy

doi:10.1059/0003-4819-82-4-466

Resolution of Primary Amyloidosis During Chemotherapy

Studies in a Patient with Nephrotic Syndrome

Durham, North Carolina, Washington, D.C., and Madison, Wisconsin

Abstract

A patient with primary amyloidosis with evidence for a plasma cell dyscrasia but no abnormal immunoglobulin components had nephrotic syndrome with severe renal impairment. Kidney and bone marrow had extensive amyloid infiltration. She was treated with penicillamine, melphalan, prednisone, and fluoxymesterone; through 6 months renal function gradually improved; urine protein excretion dropped dramatically, serum albumin rose; liver size decreased; the bone marrow returned towards normal. During the next 4½ years melphalan, prednisone, and fluoxymesterone treatment was continued with further improvement in renal function to normal levels. The morphologic characteristics and cellular relations of the amyloid fibrils in the bone marrow were studied before, during, and after successful chemotherapy; the findings are evidence for a dual role for the reticuloendothelial cell in the formation and destruction of primary amyloidosis. This patient's response suggests that a multi-agent chemotherapy approach should be further studied.

Article and Author Information

▸From the Duke University Medical Center and the Division of Hematology, Veterans Administration Hospital, Durham, North Carolina; the Division of Hematology, George Washington University Medical Center, and the Department of Medicine, Georgetown University Medical Center, Washington, D.C.; and the Department of Pathology, University of Wisconsin, Madison, Wisconsin.
A preliminary report was published as an abstract in Clinical Research 20:512, 1972.
▸Requests for reprints should be addressed to Harvey Jay Cohen, M.D., Hematology Division, Veterans Administration Hospital, Durham, NC 27705.
- Received July 19, 1974.
- Accepted November 7, 1974.