ABSTRACT
Complete elimination of the plasma cell dyscrasia is a rational therapeutic goal, as intercepting supply of precursor protein is a necessary condition for a major regression of amyloid deposits. High-dose melphalan with autologous stem cell transplantation has shown the ability to induce complete hematological response (HR) along with recovery of organ dysfunction. However, the rate of HR with this treatment rarely exceeds 40%. We describe here the first known case of successful reduced intensity allogeneic stem cell transplantation (RIST) for a patient with primary amyloidosis complicated with nephrotic syndrome but without cardiac disease, who had obtained only partial HR by high-dose melphalan with autologous stem cell transplantation. RIST may be feasible and be capable of achieving complete HR along with recovery from nephrotic syndrome with acceptable toxicity.
Subject(s)
Amyloidosis/therapy , Hematopoietic Stem Cell Transplantation/methods , Melphalan/therapeutic use , Paraproteinemias/therapy , Amyloidosis/complications , Humans , Male , Middle Aged , Nephrotic Syndrome/etiology , Nephrotic Syndrome/therapy , Paraproteinemias/complications , Proteinuria/etiology , Proteinuria/therapy , Remission Induction/methods , Salvage Therapy/methods , Transplantation, Homologous , Treatment FailureABSTRACT
We report a patient with myelodysplastic syndrome (MDS) overt leukemia who developed an acute myeloid leukemia (AML) in donor cells shortly after bone marrow transplantation (BMT) from his HLA-matched sibling. Molecular analysis using microsatellite repeats by polymerase chain reaction proved the new leukemia to be of donor cell origin. The patient received chemotherapy with idarubicin and ara-C, but he died due to mucormycosis.
