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¿µ³²ÀÇ´ëÇмúÁö Vol.24_No.2 Suppl. P.S676-682, Dec. 2007
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Case Report
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ÀÚ°¡ Á¶Ç÷¸ð¼¼Æ÷ À̽ÄÀ¸·Î Ä¡·áµÈ Àü½Å ¾Æ¹Ð·ÎÀ̵åÁõÀ» µ¿¹ÝÇÑ ´Ù¹ß¼º °ñ¼öÁ¾ 1 ¿¹ |
A Case of Multiple Myeloma with AL Amyloidosis Successfully Treated with Autologous Stem Cell Transplantation
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ÀÌÇÏ¿µ, À̰æÈñ, ±è¹Î°æ, Á¶Èñ¼ø*, Çö¸í¼ö
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¿µ³²´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç, Áø´Ü°Ë»çÀÇÇаúÇб³½Ç*
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Ã¥ÀÓÀúÀÚ£ºÇö¸í¼ö, ´ë±¸±¤¿ª½Ã ³²±¸ ´ë¸í5µ¿ 317-1, ¿µ³²´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç
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Tel: (053) 620-3837, Fax: (053) 654-8386
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E-mail: hms@med.yu.ac.kr
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December 30, 2007
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Abstract
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Myeloma is a disease of neoplastic B lymphocytes that synthesize abnormal amounts of immunoglobulin (Ig) or Ig fragments. Ten to twenty percent of myeloma patients are known to develop clinical evidence of amyloid-light chain(AL) amyloidosis. A high index of suspicion, however, is needed to make a diagnosis of amyloidosis. We report a case of multiple myeloma with AL amyloidosis successfully treated with autologous stem cell transplantation. In our case, the patient presented with longstanding abdominal discomfort and anterior chest pain. Chest X-ray showed several osteolytic changes on ribs. Endoscopic biopsy revealed massive amyloid deposits in the wall of stomach and rectum. Serum/urine protein electroporesis and bone marrow biopsy confirmed the diagnosis of multiple myeloma. At 18 months after high dose chemotherapy and autologous stem cell transplantation(ASCT), the patient maintained a complete response. In patients with multiple myeloma with AL amyloidosis, high dose chemotherapy and ASCT can be effective treatment strategy.
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Key Words: Amyloidosis, Multiple myeloma, Stem cell transplantation
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References |
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1. Alexanian R, Fraschini G, Smith L. Amyloidosis in multiple myeloma or without apparent cause. Arch Intern Med 1984;144:2158-60.
|
|
2. Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol 1995;32:45-59.
|
|
3. Gertz MA, Merlini G, Treon SP. Amyloidosis and Waldenstrom's macroglobulinemia. Hematology Am Soc Hematol Educ Program 2004;257-82.
|
|
4. Molloy CB, Peck RA, Bonny SJ, Jowitt SN, Denton J, Freemont AJ, et al. An unusual presentation of multiple myeloma: a case report. J Med Case Reports. 2007 Sep;1:84.
|
|
5. Jae Seon K, So Young K, Gwan Gyu S, Sang won S, Jun Suk K, Young-Tae B, et al. A case of systemic amyloidosis with intestinal pseudoobstruction. Korean J Gastrointest Endosc 1993;13(2):375-9.
|
|
6. Comenzo RL, Gertz MA. Autologous stem cell transplantation for primary systemic amyloidosis. Blood 2002 Jun;99(12):4276-82.
|
|
7. ±èÇüÁ¾, ¹®¼ºÁø, ±èÇöÁø, ÃÖÈÆ¿µ, ·ùµ¿¿, À¯ÅÂÇö µî. À¯ÀüºÐÁõÀÇ ÀÓ»óÀû Ư¡. ´ëÇÑ ½ÅÀåÇÐȸÁö 2005; 24(2):230-8.
|
|
8. Jaccard A, Moreau P, Leblond V, Leleu X, Benboubker L, Hermine O, et al. High-Dose Melphalan versus Melphalan plus Dexamethasone for AL Amyloidosis. N Engl J Med 2007 Jun; 357:1083-93.
|
|
9. Adam D. Cohen, Ping Zhou, Joanne Chou, Julie Teruya-Feldstein, Lilian Reich, Hani Hassoun, et al. Risk-adapted autologous stem cell transplantation with adjuvant dexamethasone ¡¾ thalidomide for systemic light-chain amyloidosis: results of a phase II trial. British journal of hematology 2007;139:224-33.
|
|
10. Sanchorawala V, Wright DG, Seldin DC, Dember LM, Finn K, Falk RH, et al. An overview of the use of high-dose melphalan with autologous stem cell transplantation for the treatment of AL amyloidosis. Bone Marrow Transplant 2001;28:637-42.
|
|
11. Dong Seon P, Woon Geon S, Min Kwan K, Jeang A L, Gyeong Mi H, Hak Yand K. A case of duodenal intramural hematoma and hemoperitoneum after therapeutic endoscopy in a patient with chronic renal failure. Korean J Gastrointest Endosc 2007;34:269-73.
|
|
12. Won M, Oh Young L, Yun Ju C, Sun Young Y, Ho Yong P, Sung Hee H, et al. The endoscopic findings and clinical characteristics of gastrointestinal amyloidosis. Korean J Gastrointest Endosc 2005;31:216-20.
|
|
13. Reich G, Held Th, Siegert W, Kampf D, Dorken B, Maschmeyer G. Four patients with AL amyloidosis treated with high-dose chemotherapy and autologous stem cell transplantation. Bone Marrow Transplant 2001;27:341-3.
|
|
14. Suk Ho L, Poong Lyul R, Jae Jun K, Kyu Taek L, Joon Hyoek L, Jong Kyun L, et al. A case of primary gastric amyloidosis diagnosed by endoscopy. Korean J Gastrointest Endosc 1998;18(4):561-6.
|
|
15. Rajkumar SV, Gertz MA, Kyle RA. Primary systemic amyloidosis with delayed progression to multiple myeloma. Cancer 1998 Apr;15(82): 1501-5.
|
|
16. Mason AR, Rackoff EM, Pollack RB. Primary systemic amyloidosis associated with multiple myeloma: a case report and review of the literature. Cutis 2007;80:193-200.
|
|
17. Yagi S, Akaike M, Ozaki S, Moriya C, Takeuchi K, Hara T, er al. Improvement of cardiac diastolic function and prognosis after autologous peripheral blood stem cell transplantation in AL cardiac amyloidosis. Intern Med 2007;46:1705-10.
|
|
18. Rysava R.AL Amyloidosis with Renal Involvement. Kidney Blood Press Res 2007;30: 359-64.
|
|
19. Sanchorawala V, Wright DG, Quillen K, Finn KT, Dember LM, Berk JL, et al. Tandem cycles of high-dose melphalan and autologous stem cell transplantation increases the response rate in AL amyloidosis. Bone Marrow Transplant 2007;40:607.
|
|
20. Skinner M, Sanchorawala V, Seldin DC, Dember LM, Falk RH, Berk JL, et al.High-dose melphalan and autologous stem-cell transplan- tation in patients with AL amyloidosis: an 8-year study. Ann Intern Med 2004;140:85-93.
|
|
21. Sanchorawala V, Wright DG, Seldin DC, Falk RH, Finn KT, Dember LM, et al. High-dose intravenous melphalan and autologous stem cell transplantation as initial therapy or following two cycles of oral chemotherapy for the treatment of AL amyloidosis: results of a prospective randomized trial.Bone Marrow Transplant 2004;33:381-8.
|
|
22. Perz JB, Schonland SO, Hundemer M, Kristen AV, Dengler TJ, Zeier M, et al.High-dose melphalan with autologous stem cell transplan- tation after VAD induction chemotherapy for treatment of amyloid light chain amyloidosis: a single centre prospective phase II study. Br J Haematol 2004;127:543-51.
|
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23. Sanchorawala V, Wright DG, Seldin DC, Dember LM, Finn K, Falk RH, et al. An overview of the use of high-dose melphalan with autologous stem cell transplantation for the treatment of AL amyloidosis. Bone Marrow Transplant 2001;28:637-42.
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24. Perz JB, Rahemtulla A, Giles C, Szydlo RM, Davis J, Gopaul D, et al.Long-term outcome of high-dose melphalan and autologous stem cell transplantation for AL amyloidosis. Bone Marrow Transplant 2006;37:937-43
|
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25. van Gameren II, Hazenberg BP, Jager PL, Smit JW, Vellenga E. AL amyloidosis treated with induction chemotherapy with VAD followed by high dose melphalan and autologous stem cell transplantation. Amyloid 2002 Sep;9 (3):165-74.
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