High-dose melphalan and auto-SCT in patients with monoclonal Ig deposition disease Journal Article


Authors: Hassoun, H.; Flombaum, C.; D'Agati, V. D.; Rafferty, B. T.; Cohen, A.; Klimek, V. M.; Boruchov, A.; Kewalramani, T.; Reich, L.; Nimer, S. D.; Comenzo, R. L.
Article Title: High-dose melphalan and auto-SCT in patients with monoclonal Ig deposition disease
Abstract: The treatment of monoclonal Ig deposition disease (MIDD) is controversial and not standardized. We report our experience with high dose melphalan and auto-SCT (HDM/auto-SCT) in seven patients with MIDD associated with underlying Durie-Salmon stage IB multiple myeloma, including five with light chain deposition disease, one with light and heavy chain deposition disease and one with light chain crystal deposition disease. The median age of these patients was 50 years; six of them were male subjects. A monoclonal κ-light chain was detected by Serum Free Light Chain Assay in all seven. The patients received melphalan 140 mg/m2 followed by auto-SCT. All patients are alive and six remain in hematologic CR with a median follow up of 23.6 months (7.9-69.8 months). Renal function has improved compared to pre-HDSM/auto-SCT in five patients - two of whom had a renal transplant and became dialysis independent - remained stable in one and worsened in one leading to hemodialysis despite hematologic CR. Our results corroborate previous experience with HDM/auto-SCT in MIDD and argue in favor of kidney transplantation in patients who achieve hematologic CR after HDM/auto-SCT. Although this approach appears effective, multi-center studies are needed to define the optimal treatment for patients with MIDD.
Keywords: adult; clinical article; controlled study; middle aged; thalidomide; doxorubicin; monotherapy; drug megadose; follow up; multiple cycle treatment; multiple myeloma; combination chemotherapy; cyclophosphamide; dexamethasone; melphalan; autologous stem cell transplantation; stem cell transplantation; assay; drug dose escalation; antibodies, monoclonal; kidney; immunoglobulin heavy chains; immunoglobulin g; kidney function; transplantation conditioning; remission; remission induction; immunoglobulin kappa chain; immunoglobulin kappa-chains; granulocyte colony stimulating factor; hemodialysis; transplantation, autologous; kidney transplantation; deterioration; kidney graft; systemic disease; myeloablative agonists; dialysis; monoclonal immunoglobulin deposition disease
Journal Title: Bone Marrow Transplantation
Volume: 42
Issue: 6
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2008-01-01
Start Page: 405
End Page: 412
Language: English
DOI: 10.1038/bmt.2008.179
PUBMED: 18574442
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 7" - "Export Date: 17 November 2011" - "CODEN: BMTRE" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Virginia Klimek
    109 Klimek
  2. Adam D Cohen
    42 Cohen
  3. Raymond L Comenzo
    112 Comenzo
  4. Hani Hassoun
    149 Hassoun
  5. Stephen D Nimer
    345 Nimer
  6. Lilian M Reich
    77 Reich