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Nephrol Dial Transplant (2003) 18: 2644-2647
© 2003 European Renal Association-European Dialysis and Transplant Association

Original Article

No regression of renal AL amyloid in monoclonal gammopathy after successful autologous blood stem cell transplantation and significant clinical improvement

Martin Zeier1, Jolanta Perz2, Reinhold P. Linke3, Ugo Donini4, Rüdiger Waldherr5, Konrad Andrassy1, Anthony D. Ho2 and Hartmut Goldschmidt2

1Department of Medicine/Nephrology, University of Heidelberg, 2Department of Medicine/Haematology, University of Heidelberg, 5Institute for Clinical Pathology, Heidelberg, 3Max-Planck-Institut für Biochemie, Martinsried, Germany and 4Divsione di Nefrologia, Ospedale M. Malphigi, Bologna, Italy

Correspondence and offprint requests to: Martin Zeier, MD, Department of Medicine/Nephrology, University of Heidelberg, Bergheimerstrasse 56a, D-69115 Heidelberg, Germany. Email: martin_zeier{at}med.uni-heidelberg.de

Background. High-dose chemotherapy followed by autologous blood stem cell transplantation induces remission of plasma cell dyscrasia in patients with AL amyloidosis. The impact of this treatment on the glomerular amyloid mass is still unknown.

Methods. In the present study, the quantity of the renal amyloid mass before and more than 3 years after high-dose melphalan treatment and autologous blood stem cell transplantation was assessed in two patients. At the time of the second renal biopsy, both patients were in complete remission without detectable serum and urinary monocloncal IgA-{lambda} and a normal percentage of plasma cells in the bone marrow.

Results. In both patients with biopsy-proven AL amyloidosis, urinary protein excretion decreased from 7 g/24 h to <2 g/24 h more than 3 years after autologous blood stem cell transplantation. In contrast, glomerular amyloid deposits persisted, as shown in the second biopsy.

Conclusion. Despite complete remission of the plasma cell dyscrasia and improvement of glomerular permeability, the amount of glomerular amyloid mass did not regress.

Keywords: AL amyloidosis; autologous stem cell transplantation; nephrotic syndrome; quantification of amyloid


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