ABSTRACT
The treatment of monoclonal Ig deposition disease (MIDD) is controversial and not standardized. We report our experience with high dose melphalan and auto-SCT (HDM/auto-SCT) in seven patients with MIDD associated with underlying Durie-Salmon stage IB multiple myeloma, including five with light chain deposition disease, one with light and heavy chain deposition disease and one with light chain crystal deposition disease. The median age of these patients was 50 years; six of them were male subjects. A monoclonal kappa-light chain was detected by Serum Free Light Chain Assay in all seven. The patients received melphalan 140 mg/m(2) followed by auto-SCT. All patients are alive and six remain in hematologic CR with a median follow up of 23.6 months (7.9-69.8 months). Renal function has improved compared to pre-HDSM/auto-SCT in five patients--two of whom had a renal transplant and became dialysis independent--remained stable in one and worsened in one leading to hemodialysis despite hematologic CR. Our results corroborate previous experience with HDM/auto-SCT in MIDD and argue in favor of kidney transplantation in patients who achieve hematologic CR after HDM/auto-SCT. Although this approach appears effective, multi-center studies are needed to define the optimal treatment for patients with MIDD.
Subject(s)
Antibodies, Monoclonal , Immunoglobulin G , Melphalan/administration & dosage , Multiple Myeloma/therapy , Myeloablative Agonists/administration & dosage , Stem Cell Transplantation , Transplantation Conditioning , Adult , Antibodies, Monoclonal/metabolism , Female , Humans , Immunoglobulin G/metabolism , Immunoglobulin Heavy Chains/metabolism , Immunoglobulin kappa-Chains/metabolism , Kidney/metabolism , Kidney/pathology , Kidney Transplantation , Male , Middle Aged , Multiple Myeloma/metabolism , Multiple Myeloma/pathology , Remission Induction , Transplantation, AutologousABSTRACT
The main use of systemic chemotherapy in metastatic melanoma remains palliative. Dacarbazine (dimethyl-1-triazeno imidazole-4-carboxamide [DTIC]) is the standard chemotherapy agent for advanced disease. The combination chemotherapy and biochemotherapy regimens have achieved higher response rates, but have not led to durable remission or improved survival. The field of systemic therapy remains in need of a more effective and less toxic treatment strategy.
Subject(s)
Antineoplastic Agents/therapeutic use , Melanoma/secondary , Skin Neoplasms/pathology , Antineoplastic Agents, Hormonal/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Dacarbazine/therapeutic use , Humans , Immunotherapy , Melanoma/drug therapy , Neoadjuvant Therapy , Palliative Care , Remission Induction , Survival RateABSTRACT
Treatment of metastatic melanoma with biochemotherapy results in the rapid onset of anemia, requiring blood transfusion in 9 of 13 (69%) patients. Prophylactic use of weekly subcutaneous recombinant epoetin alfa eliminated the need for transfusion in all but 1 of 21 (5%) patients.
