melphalan and Gastrointestinal-Hemorrhage

A 74-year-old woman with refractory IgG-κ multiple myeloma developed massive melena caused by hemorrhagic submucosal tumors in the duodenum and middle jejunum. A biopsy revealed the tumor to be marked AL amyloid deposition. Treatment with bortezomib did not improve the melena or the underlying disease. The patient also developed multiple amyloidomas in the bilateral femoral heads, which caused a fracture in the left femoral head. Treatment with lenalidomide, as the final therapeutic option, resolved the intractable melena and improved both the intestinal lesions and myeloma. This case shows that successful treatment of multiple myeloma leads to marked improvement of accompanying AL amyloidosis.

Topics: Aged; Amyloid; Amyloidosis; Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Blood Transfusion; Bone Diseases; Boronic Acids; Bortezomib; Carpal Tunnel Syndrome; Dexamethasone; Disease Progression; Doxorubicin; Duodenal Diseases; Female; Femur Head; Fractures, Spontaneous; Gastrointestinal Hemorrhage; Hip Fractures; Humans; Jejunal Diseases; Lenalidomide; Melphalan; Multiple Myeloma; Osteolysis; Prednisolone; Pyrazines; Thalidomide; Vincristine

To investigate the treatment of primary amyloidosis with high-dose melphalan and autologous hematopoietic stem cell transplantation to further examine the survival, hematologic response, and improvement of amyloid-related organ dysfunction.. Retrospective analysis of 20 patients with primary amyloidosis treated with autologous hematopoietic stem cell transplantation. The status of major organ function before transplantation, mobilization programs and conditioning regimen as possible risk factors for survival were also investigated.. Of 20 cases, 11 out of 15 evaluable cases achieved hematologic response, among them, 6 got complete remission (CR, 40%) and 5 partial remission (PR, 33%). The median onset time was 3.0 months (1.5 - 4.0 months) and 4 months (3 - 5 months), respectively after transplantation. The overall hematologic response was 73%. The 11 hematologic responders also had kidney responses. The median time to achieve kidney response was 3 months (2 - 6 months). The 3-year overall survival of the cohort of cases was 71.4%. The major causes of death were heart failure, renal dysfunction and gastrointestinal bleeding. G-CSF alone could obtain satisfactory mobilization results and most of patients well tolerated to the conditioning regimen of melphalan doses from 140 mg/m(2) to 200 mg/m(2).. Treatment of primary amyloidosis with high-dose melphalan followed by autologous peripheral blood stem cell transplantation produced high efficacy. The cardiovascular system involvement, renal dysfunction and the abnormality of coagulation function before transplantation may be the risk factors for survival.

Topics: Adult; Aged; Amyloidosis; Cardiovascular System; Female; Gastrointestinal Hemorrhage; Hematopoietic Stem Cell Transplantation; Humans; Immunoglobulin Light-chain Amyloidosis; Kidney; Male; Melphalan; Middle Aged; Retrospective Studies; Risk Factors; Survival Rate; Transplantation, Autologous; Treatment Outcome

We report the case of a 68 year-old man in whom a tumour of the colon was identified by colonoscopy, during diagnostic studies for lower gastrointestinal bleeding as an outpatient. Histological examination showed clonal proliferation of plasma cells IgG-K. No other location was affected (including bone marrow). Diagnosis of plasmacytoma of the colon was made. We have carried out a review of the literature in relation to this unusual disorder.

Topics: Adrenal Cortex Hormones; Aged; Antineoplastic Combined Chemotherapy Protocols; Colonoscopy; Combined Modality Therapy; Diverticulum; Fatal Outcome; Gastrointestinal Hemorrhage; Hemorrhoids; Humans; Lymphatic Metastasis; Male; Melphalan; Neoplasm Recurrence, Local; Plasmacytoma; Rectum; Sigmoid Neoplasms

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Electrocoagulation; Gastrointestinal Hemorrhage; Humans; Male; Melphalan; Multiple Myeloma; Recurrence; Telangiectasia, Hereditary Hemorrhagic; Thalidomide

A 45-year-old man with primary amyloidosis was initially seen with nephrotic syndrome. Factor X was found to be 5% and antithrombin III (AT III) 45% of normal plasma values. During an 11-month period, despite severe factor X deficiency, the patient did not have any bleeding complications. He developed progressive renal failure and AT III levels increased to normal, at which time he developed severe bleeding complications. These findings suggest a protective role of AT III deficiency against bleeding in a patient with severe factor X deficiency.

Topics: Amyloidosis; Antithrombin III Deficiency; Biopsy; Blood Coagulation Tests; Colchicine; Factor X Deficiency; Gastrointestinal Hemorrhage; Humans; Hypoprothrombinemias; Kidney; Male; Melphalan; Middle Aged; Nephrotic Syndrome; Prednisone; Splenectomy

Topics: Adult; Aged; Blood Coagulation Tests; Bone Marrow Examination; Busulfan; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemorrhage; Hepatomegaly; Humans; Male; Melphalan; Middle Aged; Oral Hemorrhage; Phosphorus Isotopes; Pipobroman; Polycythemia Vera; Splenomegaly; Thrombocythemia, Essential; Thrombosis; Tooth Extraction