Multiple Myeloma and AL Amyloidosis
DOI:
https://doi.org/10.24950/rspmi.779Keywords:
Amyloidosis, Immunoglobulin Light Chains, Multiple MyelomaAbstract
Both multiple myeloma and immunoglobulin light chain (AL) amyloidosis
are incurable plasma cell proliferative disorders that rarely
coexist. Approximately 10-15% of patients with multiple myeloma
develop clinical evident amyloidosis AL, being very rare the
reverse situation (0.4%). We present a case of a patient with an
undiagnosed non-secretory myeloma, i.e. with no M protein identified
in serum/urine immunoelectrophoresis or immunofixation,
who was admitted with jaundice, pruritus and a huge hepatomegaly.
The liver biopsy confirmed the diagnosis of amyloidosis
and the serum concentration of immunoglobulin free light chains
showed an excess production of kappa chains (ḳ). The authors
approach the clinical and investigation characteristicsof these two
disorders for which an early diagnosis and treatment can influence
the prognosis.
Downloads
References
JLin Pei. Plasma cell myeloma. Hematol Oncol Clin N Am. 2009; 23:709-27.
Rajkumar V, Dimopoulos M, Palumbo A, Blade Y, Merlini G, Mateos M, et al. International Myeloma Working Group updated criteria
for the diagnosis of multiple myeloma. Lancet Oncol. 2014, 15:e 538-48.
Gillmore J, Wechalekar A, Bird J, Cavenagh J, Hawkins S, Kazmi M, et al. Guidelines on the diagnosis and investigation of AL amyloidosis. Br J Haematol. 2015; 168:207-18.
Jaccard A, Desport E, Mothty D, Bridoux F. Amyloidosis AL. Rev Med Int. 2015; 36:89-97.
Müller A, Geibel A, Neumann H, Kühnemund A, Schmitt-Gräff A, Böhm J, et al. Primary (AL) Amyloidosis in plasma cell disorders.
Oncologist. 2006; 11:824-30
Bahlis NJ, Lazarus HM. Multiple myeloma-associated AL amyloidosis: is a distinctive therapeutic approach warranted? Bone Marrow
Transplant. 2006; 38:7-15
Madan S, Dispenzieri A, Lacy M, Buadi F, Hayman S, Zeldenrust S, et al. Clinical features and treatment response of light chain (AL)
amyloidosis diagnosed in patients with previous diagnosis of multiple myeloma. Mayo Clin Proc. 2010; 85:232-38.
Rajkumar S, Kyle R. Multiple Myeloma: diagnosis and treatment. Mayo Clin Proc. 2005; 80:1371-82.
Kyle R, Gertz M, Witzig T, Lust J, Lacy M, Dispenzieri A, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003; 78:21-33.
Jenner E. Serum free light chains in clinical laboratory diagnostics. Clin Chim Acta. 2014; 427:15-20.
Desport E, Bridoux F, Sirac C, Delbes S, Bender S, Fernandez B, et al. AL Amyloidosis. Orphanet J of Rare Dis. 2012; 7:54-66.
Palladini G, Merlini G. Systemic amyloidosis: what an internist should know. Eur J Intern Med. 2013; 24:729-39.
Bird J, Owen R, D’Sa S, Snowden J, Ashcroft J, Yong K, et al. Guidelines for the diagnosis and management of multiple myeloma
[accessed Jan 2015] Available from:http://www.bcshguidelines.com
Mikhael J, Dingli D, Roy V, Reeder C, Buadi F, Hayman S. Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of myeloma and risk-adapted therapy (mSMART) consensus guidelines 2013. Mayo Clin Proc. 2013; 88:360-76.
Merlini G, Wechalekar A, Palladini G. Systemic light chain amyloidosis: an update for treating physicians. Blood. 2013; 121:5124-30.
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Medicina Interna
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna
Open Access
