Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
ORIGINAL ARTICLES
Therapeutic Outcome of Cyclic VAD (Vincristine, Doxorubicin and Dexamethasone) Therapy in Primary Systemic AL Amyloidosis Patients
Ko-ichi TazawaMasayuki MatsudaTakuhiro YoshidaTakahisa GonoNagaaki KatohYasuhiro ShimojimaWataru IshiiTomohisa FushimiJun KoyamaShu-ichi Ikeda
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JOURNAL OPEN ACCESS

2008 Volume 47 Issue 17 Pages 1517-1522

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Abstract

Objective Intensive chemotherapy targeting plasma cell dyscrasia has been recently employed for the treatment of primary systemic AL amyloidosis. We prospectively studied the clinical usefulness of cyclic VAD (vincristine, doxorubicin and dexamethasone) in patients with primary systemic AL amyloidosis who were ineligible for high-dose melphalan with autologous stem cell support.
Patients and Methods Eight patients (mean age, 60.4±8.8 years) were treated with cyclic VAD until the disappearance of M-protein from both serum and urine. Of these, seven showed nephrotic syndrome before the start of VAD irrespective of a decrease in creatinine clearance. Serial follow-up studies after VAD evaluated hematological status and organ function.
Results Four patients (50%) showed a marked decrease in abnormal plasma cells in the bone marrow and normalized κ/λ ratios of serum free light chain in conjunction with disappearance of M-protein after 1 to 3 courses of VAD. There were no serious adverse events, and nephrotic syndrome gradually improved with no hematological relapse in the follow-up period of 3 to 5 years. The remaining 4 patients showed worsening of congestive heart failure and/or systemic edema ascribable to dexamethasone, resulting in cessation of cyclic VAD before disappearance of M-protein. All of these patients died of multiple organ failure or required permanent hemodialysis within 1 year after the start of cyclic VAD.
Conclusion Cyclic VAD is a potent therapeutic option in primary systemic AL amyloidosis, but in patients with renal or cardiac dysfunction careful management for adverse events, especially body fluid retention, is necessary.

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© 2008 by The Japanese Society of Internal Medicine
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