Article Dans Une Revue Haematologica Année : 2008

Successful heart transplantation following melphalan plus dexamethasone therapy in systemic AL amyloidosis.

Myriam Pujo
  • Fonction : Auteur
Annick Delcourt
  • Fonction : Auteur
Jean Marc Gombert
  • Fonction : Auteur
Jean-Michel Goujon
  • Fonction : Auteur
  • PersonId : 920028
  • IdRef : 060946911
Daniel Herpin
  • Fonction : Auteur
  • PersonId : 762200
  • IdRef : 028017927

Résumé

Recurrence in the allograft and progression in other organs increase mortality after cardiac transplantation in AL amyloidosis. Survival may be improved after suppression of monoclonal light chain (LC) production following high dose melphalan and autologous stem cell transplantation (HDM/ASCT). However, because of high treatment related mortality, this tandem approach is restricted to few patients without significant extra-cardiac involvement. A diagnosis of systemic AL amyloidosis was established in a 45-year old patient with congestive heart failure related to restrictive cardiomyopathy, nephrotic syndrome, peripheral neuropathy, postural hypotension, macroglossia, and lambda LC monoclonal gammopathy. After melphalan and dexamethasone (M-Dex) therapy, which resulted in 80% reduction of serum free lambda LC, he underwent orthotopic cardiac transplantation. Two years later, he remains in a sustained hematologic remission, with no evidence of allograft or extra-cardiac amyloid accumulation. M-Dex should be considered as an alternative therapy in AL amyloid heart transplant recipients ineligible for HDM/ASCT.

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Dates et versions

hal-00452947 , version 1 (03-02-2010)

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Aude Mignot, Frank Bridoux, Antoine Thierry, Shaida Varnous, Myriam Pujo, et al.. Successful heart transplantation following melphalan plus dexamethasone therapy in systemic AL amyloidosis.. Haematologica, 2008, 93 (3), pp.e32-5. ⟨10.3324/haematol.12108⟩. ⟨hal-00452947⟩
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