Multiple myeloma associated secondary systemic AL-amyloidosis: a case report and a literature review
Rudiuk T.1, Novosad O.2, Shevchuk L.2, Kundina V.3, Nepomnyashchiy V.4, Schmidt A.5, Kriachok I.A.2
- 1National Medical University named after O.O. Bogomolets, Kyiv
- 2National Cancer Institute, Kyiv
- 3Shupyk National Healthcare University of Ukraine, Kyiv
- 4Institute of Nephrology, National Academy of Medical Sciences of Ukraine, Kyiv
- 5Heart Institute of the Ministry of Health of Ukraine, Kyiv
Summary. AL-amyloidosis is a systemic type of disease characterized by aggregation of improperly folded immunoglobulin light chain, mainly in the heart and kidneys, causing organ failure. This article describes the clinical experience of managing a patient with cardiac amyloidosis associated with multiple myeloma. The diagnosis of amyloidosis is based on a high index of clinical suspicion. Unfortunately, in the early stages, the disease is often asymptomatic until it progresses to the end stages, and even then, the symptoms can be very nonspecific. Protracted time to diagnosis, often more than one year, is a common factor in poor treatment outcomes. The slow progression of the disease, in most cases, leads to fatal consequences, since initially patients do not go to dedicated specialists. Congestive heart failure and cardiac arrhythmia are common causes of death from primary systemic amyloidosis, accounting for 48% to 65% of the causes of death of cardiovascular manifestations. More accurate recognition of AL-amyloidosis by cardiologists lets prescribe treatment as early as possible and improve its results. Traditional treatments of multiple myeloma and AL amyloidosis include the combination of dexamethasone with bortezomib and endoxan. Hematopoietic stem cell transplantation after high doses of melphalan has become another treatment option that leads to remission. Presented as the clinical report of timely complete diagnosis and treatment of a combination of these two diseases, as a result of which the patient achieved a complete hematological and partially organ response to the underlying disease.
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