Elotuzumab in Combination with Lenalidomide and Dexamethasone for Treatment-resistant Immunoglobulin Light Chain Amyloidosis With Multiple Myeloma

2019 ◽  
Vol 19 (1) ◽  
pp. e33-e36 ◽  
Author(s):  
Shumaila Muhammad Iqbal ◽  
Kathryn Stecklein ◽  
Joseph Sarow ◽  
Michael Krabak ◽  
Jens Hillengass ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Treatment Resistant ◽  
Immunoglobulin Light Chain ◽  
Light Chain Amyloidosis ◽  
Immunoglobulin Light Chain Amyloidosis

scholarly journals Diaphragmatic Amyloidosis Causing Respiratory Failure: A Case Report and Review of Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Aleksey Novikov ◽  
Horatio Holzer ◽  
Robert A. DeSimone ◽  
Ghaith Abu-Zeinah ◽  
David J. Pisapia ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Respiratory Failure ◽  
Light Chain ◽  
Phrenic Nerve ◽  
Early Recognition ◽  
Pulmonary Function Tests ◽  
Rapid Progression ◽  
Immunoglobulin Light Chain ◽  
Light Chain Amyloidosis ◽  
Immunoglobulin Light Chain Amyloidosis

Neuromuscular respiratory failure is a rare complication of systemic immunoglobulin light chain amyloidosis. We describe a case of a 70-year-old Caucasian man with multiple myeloma who presented with worsening dyspnea. The patient was diagnosed with and treated for congestive heart failure but continued to suffer from hypercapnic respiratory insufficiency. He had restrictive physiology on pulmonary function tests and abnormal phrenic nerve conduction studies, consistent with neuromuscular respiratory failure. The diagnosis of systemic immunoglobulin light chain amyloidosis was made based on the clinical context and a cardiac biopsy. Despite treatment attempts, the patient passed away in the intensive care unit from hypercapnic respiratory failure. Autopsy revealed dense diaphragmatic amyloid deposits without phrenic nerve infiltration or demyelination or lung parenchymal involvement. Only 5 cases of neuromuscular respiratory failure due to amyloid infiltration of the diaphragm have been described. All cases, including this, were characterized by rapid progression and high mortality. Therefore, diaphragmatic amyloidosis should be on the differential for progressive neuromuscular respiratory failure in patients with multiple myeloma or any other monoclonal gammopathy. Given its poor prognosis, early recognition of this condition is essential in order to address goals of care and encourage pursuit of palliative measures.

Immunoglobulin light-chain amyloidosis shares genetic susceptibility with multiple myeloma

Leukemia ◽  
2014 ◽  
Vol 28 (11) ◽  
pp. 2254-2256 ◽  
Author(s):  
N Weinhold ◽  
A Försti ◽  
M I da Silva Filho ◽  
J Nickel ◽  
C Campo ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Genetic Susceptibility ◽  
Light Chain ◽  
Immunoglobulin Light Chain ◽  
Light Chain Amyloidosis ◽  
Immunoglobulin Light Chain Amyloidosis

scholarly journals The prognostic value of diagnosing concurrent multiple myeloma in immunoglobulin light chain amyloidosis

2013 ◽  
Vol 161 (3) ◽  
pp. 367-372 ◽  
Author(s):  
Shira Dinner ◽  
Wesley Witteles ◽  
Ronald Witteles ◽  
Anthony Lam ◽  
Sally Arai ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Prognostic Value ◽  
Immunoglobulin Light Chain ◽  
Light Chain Amyloidosis ◽  
Immunoglobulin Light Chain Amyloidosis

scholarly journals Genetic pathogenesis of immunoglobulin light chain amyloidosis: basic characteristics and clinical applications

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Linchun Xu ◽  
Yongzhong Su
Keyword(s):  
Plasma Cell ◽  
Light Chain ◽  
Amyloid Fibril ◽  
Treatment Modalities ◽  
Driver Gene ◽  
Immunoglobulin Light Chain ◽  
Disease Evolution ◽  
Genetic Aberrations ◽  
Light Chain Amyloidosis ◽  
Immunoglobulin Light Chain Amyloidosis

AbstractImmunoglobulin light chain amyloidosis (AL) is an indolent plasma cell disorder characterized by free immunoglobulin light chain (FLC) misfolding and amyloid fibril deposition. The cytogenetic pattern of AL shows profound similarity with that of other plasma cell disorders but harbors distinct features. AL can be classified into two primary subtypes: non-hyperdiploidy and hyperdiploidy. Non-hyperdiploidy usually involves immunoglobulin heavy chain translocations, and t(11;14) is the hallmark of this disease. T(11;14) is associated with low plasma cell count but high FLC level and displays distinct response outcomes to different treatment modalities. Hyperdiploidy is associated with plasmacytosis and subclone formation, and it generally confers a neutral or inferior prognostic outcome. Other chromosome abnormalities and driver gene mutations are considered as secondary cytogenetic aberrations that occur during disease evolution. These genetic aberrations contribute to the proliferation of plasma cells, which secrete excess FLC for amyloid deposition. Other genetic factors, such as specific usage of immunoglobulin light chain germline genes and light chain somatic mutations, also play an essential role in amyloid fibril deposition in AL. This paper will propose a framework of AL classification based on genetic aberrations and discuss the amyloid formation of AL from a genetic aspect.

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