melphalan and Proteinuria

Many patients with systemic amyloidosis are underdiagnosed. Overall, 25% of patients with immunoglobulin light chain (AL) amyloidosis die within 6 months of diagnosis and 25% of patients with amyloid transthyretin (ATTR) amyloidosis die within 24 months of diagnosis. Effective therapy exists but is ineffective if end-organ damage is severe.. To provide evidence-based recommendations that could allow clinicians to diagnose this rare set of diseases earlier and enable accurate staging and counseling about prognosis.. A comprehensive literature search was conducted by a reference librarian with publication dates from January 1, 2000, to December 31, 2019. Key search terms included amyloid, amyloidosis, nephrotic syndrome, heart failure preserved ejection fraction, and peripheral neuropathy. Exclusion criteria included case reports, non-English-language text, and case series of fewer than 10 patients. The authors independently selected and appraised relevant literature.. There was a total of 1769 studies in the final data set. Eighty-one articles were included in this review, of which 12 were randomized clinical trials of therapy that included 3074 patients, 9 were case series, and 3 were cohort studies. The incidence of AL amyloidosis is approximately 12 cases per million persons per year and there is an estimated prevalence of 30 000 to 45 000 cases in the US and European Union. The incidence of variant ATTR amyloidosis is estimated to be 0.3 cases per year per million persons with a prevalence estimate of 5.2 cases per million persons. Wild-type ATTR is estimated to have a prevalence of 155 to 191 cases per million persons. Amyloidosis should be considered in the differential diagnosis of adult nondiabetic nephrotic syndrome; heart failure with preserved ejection fraction, particularly if restrictive features are present; unexplained hepatomegaly without imaging abnormalities; peripheral neuropathy with distal sensory symptoms, such as numbness, paresthesia, and dysesthesias (although the autonomic manifestations occasionally may be the presenting feature); and monoclonal gammopathy of undetermined significance with atypical clinical features. Staging can be performed using blood testing only. Therapeutic decision-making for AL amyloidosis involves choosing between high-dose chemotherapy and stem cell transplant or bortezomib-based chemotherapy. There are 3 therapies approved by the US Food and Drug Administration for managing ATTR amyloidosis, depending on clinical phenotype.. All forms of amyloidosis are underdiagnosed. All forms now have approved therapies that have been demonstrated to improve either survival or disability and quality of life. The diagnosis should be considered in patients that have a multisystem disorder involving the heart, kidney, liver, or nervous system.

Topics: Algorithms; Benzoxazoles; Dexamethasone; Diagnosis, Differential; Gene Silencing; Heart Failure; Humans; Immunoglobulin Light-chain Amyloidosis; Liver Transplantation; Melphalan; Prognosis; Proteinuria; Stem Cell Transplantation

Topics: Aged; Amyloidosis; Anti-Inflammatory Agents; Dexamethasone; Diagnosis, Differential; Disease Progression; Early Diagnosis; Fatal Outcome; Female; Heart Failure; Humans; Immunosuppressive Agents; Mass Screening; Melphalan; Myeloablative Agonists; Nurse's Role; Patient Education as Topic; Pleural Effusion; Proteinuria; Rare Diseases; Stem Cell Transplantation; Thalidomide

Primary systemic (AL) amyloidosis is a rare plasma cell disorder characterized by soft-tissue deposition of monoclonal light chain fragments. High-dose melphalan followed by autologous stem cell transplantation currently has become the treatment of choice. Favorable outcome is ensured with achievement of hematologic response, but little is known about organ response. This study was undertaken to determine the prognostic importance of renal response after high-dose melphalan and stem cell transplantation.. All patients with AL amyloidosis who underwent autologous stem cell transplantation between 1996 and December 2002 were selected for study. Renal response is defined as a 50% or greater reduction in proteinuria with less than 25% decline in renal function. Exclusion criteria included pretransplantation dialysis therapy or dialysis dependence posttransplantation, treatment mortality, lack of proteinuria assessment posttransplantation, and baseline proteinuria with protein less than 1 g/d.. Of 105 patients, 47 were excluded for stated reasons. Renal response was achieved in 60.3% of evaluated patients. Proteinuria was reduced by greater than 90% in 37.9% and returned to normal in 15.5%. Median response time was 12 months. Renal response was associated with a greater increase in serum albumin level (P = 0.001), maintenance of renal function (P < 0.001), and better survival (P = 0.0003). Renal responders had better survival regardless of hematologic response (P = 0.01 to 0.05).. Currently, high-dose melphalan followed by stem cell transplantation is the most effective treatment for AL amyloidosis for those who are eligible. Our data show that renal response after high-dose melphalan followed by stem cell transplantation is associated with improved survival. Renal response is an independent marker of treatment success and can be used in cases in which determination of hematologic response is difficult.

Topics: Adult; Aged; Amyloidosis; Cohort Studies; Combined Modality Therapy; Female; Humans; Kidney; Kidney Function Tests; Male; Melphalan; Middle Aged; Peripheral Blood Stem Cell Transplantation; Proteinuria; Retrospective Studies; Survival Analysis; Transplantation Conditioning; Transplantation, Autologous; Treatment Outcome

Focal and segmental glomerulosclerosis (FSGS) is a common histological finding in patients with proteinuria. The natural history of the condition varies, and although it may be responsive to therapy, FSGS is an important cause of end-stage renal disease. FSGS can be caused by a variety of conditions, but it has been reported rarely in association with a plasma cell disorder.. Mayo Clinic databases were queried and cross-referenced for FSGS and plasma cell disorders. The diagnoses were confirmed, and relevant clinical and laboratory data were abstracted.. A cohort of 13 patients with "idiopathic" FSGS and a monoclonal plasma cell disorder were identified. Four patients had myeloma, and 9 patients had monoclonal gammopathy of undetermined significance. Patients treated for myeloma experienced improvement in their renal lesion, and the latter relapsed when the myeloma relapsed.. We show that FSGS and plasma cell disorders are temporally and epidemiologically linked. Therapy for the underlying plasma cell disorder can lead to resolution of FSGS. The emerging molecular pathogenesis of both FSGS and myeloma also provides potential mechanisms that link the 2 conditions together. Thus, physicians must rule out a plasma cell proliferative disorder in patients with FSGS before concluding that the renal lesion is idiopathic. Moreover, FSGS may respond favorably after the underlying plasma cell disorder is controlled.

Topics: Aged; Amyloidosis; Antibodies, Monoclonal; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cohort Studies; Combined Modality Therapy; Comorbidity; Cytokines; Databases, Factual; Dexamethasone; Female; Glomerulosclerosis, Focal Segmental; Humans; Immunoglobulin Light Chains; Kidney; Male; Melphalan; Metabolic Clearance Rate; Middle Aged; Multiple Myeloma; Myeloma Proteins; Paraneoplastic Syndromes; Paraproteinemias; Peripheral Blood Stem Cell Transplantation; Prednisone; Prevalence; Proteinuria; Recurrence; Remission Induction; Retrospective Studies; Time Factors; Vasculitis

Topics: Allopurinol; Androstanes; Antineoplastic Agents; Blood Proteins; Cyclophosphamide; Follow-Up Studies; Glucocorticoids; Humans; Melphalan; Plasmacytoma; Prednisone; Proteinuria

The impact of high dose dexamethasone containing regimens with or without the novel agents thalidomide and bortezomib on the reversal of renal failure (RF) was evaluated in 41 consecutive newly diagnosed patients with multiple myeloma (MM) treated in a single institution. RF was reversed in 73% of all patients within a median of 1.9 months. In patients treated with dexamethasone and novel agents (thalidomide and/or bortezomib) the reversibility rate was 80% within a median of 0.8 months. Severe RF and significant Bence Jones proteinuria were associated with a lower probability of RF reversal. Patients who responded to treatment achieved RF reversal more often than in those who did not (85% versus 56%, p=0.046). In conclusion, RF is reversible in the majority of newly diagnosed MM patients treated with high-dose dexamethasone containing regimens. The addition of novel agents induces a more rapid RF reversal.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bence Jones Protein; Boronic Acids; Bortezomib; Dexamethasone; Doxorubicin; Female; Humans; Hypercalcemia; Kidney Failure, Chronic; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloma Proteins; Proteinuria; Pyrazines; Thalidomide; Treatment Outcome; Vincristine

Three hundred and seventy-two patients were randomized between 3 regimens of chemotherapy: cyclophosphamide, intermittent melphalan, and melphalan with prednisone, and were followed up to death or for at least 5 years. There was no difference in survival between the treatments, either overall or in any subgroup of patients. Therefore, the choice among these 3 treatments should be guided by the patient's comfort and convenience. The most important prognostic feature at presentation was the quality of renal function. It was possible to define good, intermediate and poor renal-function groups which were highly correlated with prognosis (X2 for trend = 62.6). The haemoglobin level at presentation was strongly correlated with prognosis among patients in the good renal-function group. Among 107 patients who presented with good renal function and with haemoglobin above 100 g/l, the 5-year survival was 43%. Other prognostic features were much less important when account was taken of renal function and haemoglobin level.

Topics: Aged; Clinical Trials as Topic; Cyclophosphamide; Drug Therapy, Combination; Follow-Up Studies; Hemoglobinometry; Humans; Immunoglobulin M; Kidney Diseases; Melphalan; Middle Aged; Multiple Myeloma; Prednisone; Prognosis; Proteinuria; Urea

Satisfactory treatment for primary amyloidosis does not exist. Because the amyloid fibrils consist of a portion of a monoclonal light chain, it appears reasonable to treat amyloidosis with alkylating agents that are effective against the plasma cells that synthesize monoclonal light chains. Fifty-five patients with primary systemic amyloidosis were randomized (double blind) to melphalan-prednisone or placebo. In comparison with the placebo group, patients given melphalan-prednisone were able to continue on treatment for a longer time and to receive larger doses before the code was broken. Among this group, the nephrotic syndrome disappeared in two patients and urinary excretion of protein was reduced by more than 50% in eight others. Of 13 patients who received melphalan-prednisone for more than 12 mo, 6 improved, 3 were stable, and 4 had progression of disease. Survival did not differ significantly between the groups.

Topics: Alkaline Phosphatase; Amyloidosis; Blood Coagulation; Clinical Trials as Topic; Creatinine; Double-Blind Method; Drug Therapy, Combination; Humans; Immunoelectrophoresis; Melphalan; Placebos; Prednisone; Proteinuria

Topics: Adult; Aged; Alkaline Phosphatase; Bence Jones Protein; Calcium; Cyclophosphamide; Female; Hemoglobins; Humans; Immunoglobulin M; Male; Melphalan; Middle Aged; Multiple Myeloma; Prognosis; Proteinuria; Radiography; Serum Albumin; Urea

An 11 year old female-neutered Labrador presented for facial swelling. Clinicopathological abnormalities included hyperglobulinemia, azotemia, hypercalcemia, nonregenerative anemia, thrombocytopenia, and spurious hypoglycemia. Normoglycemia was subsequently confirmed using a cage-side analyzer (AlphaTRAK, Zoetis, UK). Serum and urine protein electrophoresis documented monoclonal (immunoglobulin M) gammopathy with Bence-Jones proteinuria. Computed tomography imaging revealed a monostotic osteolytic bone-lesion, and bone marrow cytology and histopathology documented plasmacytosis with multiple myeloma oncogene 1 / interferon regulatory factor 4 positivity, consistent with multiple myeloma. Infectious disease testing initially indicated seropositivity for Leishmania, Borrelia, and Anaplasma spp.; however, Leishmania PCR (splenic and bone marrow aspirates), and paired serological titers for Borrelia and Anaplasma were negative. Consequently, initial serological results were considered to be false positive because of paraproteinemia-associated assay interference. Chemotherapy (prednisolone and melphalan combination therapy) was initiated, but the dog was euthanased 30 days later because of the development of pericardial effusion. This is a report of spurious serological (and other laboratory) results occurring secondary to monoclonal gammopathy in a dog.

Topics: Animals; Bone Marrow; Dog Diseases; Dogs; Female; Immunoglobulin M; Melphalan; Multiple Myeloma; Proteinuria

Topics: Glomerular Filtration Rate; Humans; Immunoglobulin Light-chain Amyloidosis; Kidney; Melphalan; Prognosis; Proteinuria; Stem Cell Transplantation

A 57-year-old Japanese woman with a 5-year history of rheumatoid arthritis (RA) was admitted to our hospital for an evaluation of nephrotic range proteinuria (4.8 g/day). A renal biopsy led to the diagnosis of amyloidosis according to strong positivity for Congo red staining and the detection of microfibrillar structures on electron microscopy that were negative for AA and positive for kappa light chain. Combination therapy with high-dose melphalan and autologous stem cell transplantation was performed according to the regimen for AL amyloidosis. Her proteinuria and RA subsided, but relapsed after 3 years. This is the first report regarding kappa light chain amyloidosis in an RA patient.

Topics: Amyloidosis; Antineoplastic Agents, Alkylating; Arthritis, Rheumatoid; Combined Modality Therapy; Female; Hematopoietic Stem Cell Transplantation; Humans; Melphalan; Middle Aged; Proteinuria

We report four cases of de novo amyloidosis occurring after 16, 18, 28 and 31 years following kidney transplantation. These patients presented with proteinuria and progressive allograft dysfunction. Kidney biopsy showed AL amyloidosis in all compartments of the allograft kidney. Serum immunofixation studies revealed monoclonal lambda light chains in all four cases. Bone marrow examination showed 10% plasma cells in one case, 5-10% in two cases and less than 5% in one case. Two patients died unexpectedly within 3 months and 1 year of the diagnosis of allograft AL amyloidosis. Of the remaining two, one underwent autologous stem cell transplant that resulted in complete hematologic remission. However, the patient relapsed within 2 years and also developed progressive kidney allograft failure. The patient received a second autologous stem cell transplant with complete hematologic response, followed by a second kidney transplant, which showed no evidence of amyloid at 1-year posttransplant. The remaining case was treated with prednisone and bortezomib, which has stabilized kidney function in the short term. In conclusion, this study shows that AL amyloidosis is an uncommon but important cause of late onset proteinuria in the kidney allograft that results in kidney allograft failure.

Topics: Amyloidosis; Antineoplastic Combined Chemotherapy Protocols; Boronic Acids; Bortezomib; Female; Hematopoietic Stem Cell Transplantation; Humans; Kidney Transplantation; Male; Melphalan; Middle Aged; Prednisone; Proteinuria; Pyrazines; Remission Induction; Treatment Outcome

Multiple Myeloma has been recognized since Ancient Times. The first well-documented case was reported in 1844 by Samuel Solly. The most commonly recognized case is that of Thomas Alexander McBean, a highly respectable tradesman from London in 1850. Mr. McBean excreted a large amount of protein that was described by Henry Bence Jones in the middle of the 19th century. Jones was a well-known physician and made many contributions to medicine. One of the best known cases of multiple myeloma was that of Dr. Loos that was reported by Otto Kahler. The recognition of plasma cells and subsequently their product, a monoclonal protein has been described in detail. The authors have reviewed the treatment of multiple myeloma including the novel agents, thalidomide, bortezomib and lenalidomide.

Topics: Adrenal Cortex Hormones; Alkylating Agents; Bence Jones Protein; Boronic Acids; Bortezomib; History, 19th Century; History, Ancient; Humans; Lenalidomide; Melphalan; Multiple Myeloma; Paraproteinemias; Prednisone; Proteinuria; Pyrazines; Stem Cell Transplantation; Thalidomide; Urethane

Topics: Antineoplastic Combined Chemotherapy Protocols; Biopsy; Combined Modality Therapy; Cyclophosphamide; Dexamethasone; Doxorubicin; Glomerular Mesangium; Glomerulonephritis; Humans; Immunoglobulin kappa-Chains; Magnetic Resonance Imaging; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloma Proteins; Peripheral Blood Stem Cell Transplantation; Proteinuria; Remission Induction; Transplantation, Autologous; Vincristine

Complete elimination of the plasma cell dyscrasia is a rational therapeutic goal, as intercepting supply of precursor protein is a necessary condition for a major regression of amyloid deposits. High-dose melphalan with autologous stem cell transplantation has shown the ability to induce complete hematological response (HR) along with recovery of organ dysfunction. However, the rate of HR with this treatment rarely exceeds 40%. We describe here the first known case of successful reduced intensity allogeneic stem cell transplantation (RIST) for a patient with primary amyloidosis complicated with nephrotic syndrome but without cardiac disease, who had obtained only partial HR by high-dose melphalan with autologous stem cell transplantation. RIST may be feasible and be capable of achieving complete HR along with recovery from nephrotic syndrome with acceptable toxicity.

Topics: Amyloidosis; Hematopoietic Stem Cell Transplantation; Humans; Male; Melphalan; Middle Aged; Nephrotic Syndrome; Paraproteinemias; Proteinuria; Remission Induction; Salvage Therapy; Transplantation, Homologous; Treatment Failure

Dose-intensive intravenous melphalan with autologous blood stem-cell transplantation induces remission of the plasma cell dyscrasia in a substantial proportion of patients with AL amyloidosis. The impact of this treatment on associated renal disease is not known.. To determine the effect of dose-intensive intravenous melphalan and autologous blood stem-cell transplantation on AL amyloidosis-associated renal disease.. Prospective cohort study.. Academic medical center.. 65 patients with AL amyloidosis and urinary protein excretion greater than 1 g/24 h who received dose-intensive intravenous melphalan and autologous blood stem-cell transplantation between 1 July 1994 and 30 June 1998.. 24-hour urinary protein excretion, serum cholesterol level, serum albumin level, creatinine clearance, urine and serum immunoelectrophoresis, and bone marrow biopsy. Renal response was defined as a greater than 50% reduction in urinary protein excretion in the absence of a 25% or greater reduction in creatinine clearance. Complete hematologic response was defined as absence of detectable monoclonal protein in serum and urine and a bone marrow specimen containing less than 5% plasma cells without clonal dominance of kappa or lambda isotype.. Among the 50 patients who survived for at least 12 months, proteinuria, hypoalbuminemia, and hypercholesterolemia improved during follow-up; 36% met criteria for a renal response. Median 24-hour urinary protein excretion decreased from a baseline value of 9.6 g/24 h to 1.6 g/24 h at 12 months among patients with complete hematologic response, and 71% met criteria for a renal response. Twenty-hour urinary protein excretion did not decrease during follow-up among patients with persistent plasma cell disease, and only 11% had a renal response at 12 months (P < 0.001 for hematologic responders vs. nonresponders).. Dose-intensive intravenous melphalan with autologous blood stem-cell transplantation improves the nephrotic syndrome in patients with AL amyloidosis-associated renal disease. The benefit is largely limited to patients achieving eradication of the underlying plasma cell dyscrasia.

Topics: Adult; Aged; Amyloidosis; Cholesterol; Combined Modality Therapy; Female; Follow-Up Studies; Hematopoietic Stem Cell Transplantation; Humans; Hypercholesterolemia; Infusions, Intravenous; Male; Melphalan; Middle Aged; Nephrotic Syndrome; Proteinuria; Transplantation, Autologous; Treatment Outcome

Despite significant effects of melphalan and prednisone in the therapy of systemic AL-amyloidosis, overall prognosis is poor and remission of clinical symptoms cannot generally be expected. The course of the disease and results of therapy are possibly influenced by the degree and distribution of organ manifestation at the time of diagnosis. We report a group of patients with renal involvement as the main manifestation of disease.. Fifteen patients with systemic Al-amyloidosis without symptomatic myeloma (4 women, 11 men, median age 61 [34 to 71] years) have been attended to at our department and were treated throughout the course of the disease.. Since primary symptoms were frequently unspecific, the maximum time to diagnosis came to 28 months. Renal involvement was primarily evident at the time of diagnosis when all patients manifested proteinuria or renal insufficiency. Ten patients were treated with a melphalan and prednisone containing chemotherapeutic protocol. A significant clinical improvement was observed in no case. One patient in an advanced stage of disease died after the administration of a high-dose regimen of melphalan with blood stem-cell support subsequent to sepsis.. We do not see an absolute indication for chemotherapy. The unfavorable prognosis--14 patients died an average of 13 months after diagnosis--requires a particularly careful consideration of potential benefits and possible risks accompanying cytostatic therapy.

Topics: Adult; Aged; Amyloidosis; Edema; Female; Humans; Kidney Failure, Chronic; Male; Melphalan; Middle Aged; Paresthesia; Prednisone; Prognosis; Proteinuria; Survival Rate

Topics: Adult; Aged; Amyloidosis; Colchicine; Humans; Kidney; Kidney Function Tests; Male; Melphalan; Nephrotic Syndrome; Prednisone; Proteinuria

Topics: Aged; Body Height; Body Weight; Diagnostic Errors; gamma-Globulins; Humans; Kyphosis; Male; Melphalan; Multiple Myeloma; Proteinuria

A 33-year-old man with overall renal function in the lower normal range had daily excretion in the urine of between 31 and 70 gm of protein composed entirely of free monoclonal K light chains. K light chains were also present in the serum. Serum protein electrophoresis and findings on bone marrow and lymph node biopsy were diagnostic of light chain disease. Amyloid was absent from renal tissue. General clinical improvement and almost total disappearance of protein from the urine followed treatment with phenylalanine mustard.

Topics: Adult; Allopurinol; Humans; Immunoglobulin kappa-Chains; Immunoglobulin Light Chains; Male; Melphalan; Paraproteinemias; Proteinuria

Urine specimens from patients with multiple myeloma and Bence Jones proteinuria frequently contain low molecular weight proteins which correspond either to the amino-terminal, variant half (VL) or to the carboxyl-terminal, constant half (CL) of the Bence Jones protein. Analyses of urine specimens from such patients who had received high doses of corticosteroids as part of their treatment regimen revealed that concomitantly with a decrease in Bence Jones protein excretion was the appearance of a low molecular weight protein related to the Bence Jones protein but not identical to the VL or to the CL. Analyses of daily urine specimens obtained from one such patient over an extended time period revealed that a reproducible chain of events occurred during a treatment regimen which included oral administration of 75 mg of prednisone daily for 7 consecutive days. The amount of Bence Jones protein excreted decreased progressively, and by the 5th day was usually less than 10% of the pretreatment value. The urine specimen obtained on the 6th day of treatment was virtually devoid of Bence Jones protein but contained a newly appearing protein whose electrophoretic mobility was distinct from that of the Bence Jones protein or its VL or CL. Cessation of corticosteroid therapy resulted in a prompt disappearance of the new protein and in a progressive increase in the amount of Bence Jones protein excreted. The new protein was isolated from the urine of this patient and was purified for comparative studies with Bence Jones protein and with the VL and CL prepared by specific enzymatic cleavage of the Bence Jones protein. These studies revealed that the new protein was most related antigenically to the CL, but could be distinguished immunochemically from the CL. This new protein, a component found in vivo related to the constant half of the light polypeptide chain, was designated CL, and was structurally 25 amino acid residues longer than the CL, that is, the amino-terminus of the enzymatically prepared CL was at position 117 whereas that of the transitory new Bence Jones-related protein was at position 92 of the light polypeptide chain. Biosynthetic studies were performed with plasma cells derived from the bone marrow of this patient at a time when both the CL and the Bence Jones protein were being excreted; both proteins were identified in extracellular culture fluid by immunochemical techniques. Whether the CL is of synthetic or catabolic origin is presently not known; h

Topics: Amino Acid Sequence; Antineoplastic Agents; Bence Jones Protein; Bone Marrow; Bone Marrow Cells; Carmustine; Cyclophosphamide; Electrophoresis; Electrophoresis, Starch Gel; Female; Humans; Immunodiffusion; Immunoelectrophoresis; Immunoglobulin Fragments; Melphalan; Middle Aged; Molecular Weight; Multiple Myeloma; Prednisone; Proteinuria

This group of proliferative diseases of the plasma cell line, in which manifestations of abnormal immunoglobulin production are associated with variable degrees of depressed antibody synthesis, pose fascinating problems crossing many clinical and research disciplines. The present state of diagnosis and clinical management is assessed.

Topics: Alkylating Agents; Amyloidosis; Antibodies, Anti-Idiotypic; Bence Jones Protein; Blood Cell Count; Blood Proteins; Bone Marrow; Bone Marrow Cells; Cyclophosphamide; Drug Therapy, Combination; Heavy Chain Disease; Humans; Immunoelectrophoresis; Immunoglobulins; Kidney Diseases; Melphalan; Multiple Myeloma; Prednisone; Proteinuria

Topics: Bone Marrow Examination; Carbohydrates; Chromatography, Ion Exchange; Cyclophosphamide; Electrophoresis, Polyacrylamide Gel; Heavy Chain Disease; Humans; Immunodiffusion; Immunoelectrophoresis; Immunoglobulin Fragments; Immunoglobulin G; Male; Melphalan; Middle Aged; Neuraminic Acids; Papain; Plasma Cells; Prednisone; Proteinuria; Pseudomonas Infections; Ultracentrifugation

Topics: Alopecia; Amyloidosis; Blood Proteins; Drug Therapy, Combination; Eye Manifestations; Humans; Immunoglobulin D; Immunoglobulin Fragments; Keratosis; Male; Melphalan; Middle Aged; Mucinosis, Follicular; Mucous Membrane; Multiple Myeloma; Nails; Plasmacytoma; Prednisolone; Proteinuria; Scalp; Skin; Syndrome; Trichophyton

Topics: Amyloidosis; Blood Cell Count; Blood Platelets; Blood Transfusion; Bone Marrow Examination; Cephalothin; Cytarabine; Erythrocytes; Gentamicins; Hemoglobins; Humans; Leukemia, Myeloid, Acute; Male; Melphalan; Middle Aged; Proteinuria; Thioguanine

Topics: Allopurinol; Bence Jones Protein; Drug Therapy, Combination; Female; Humans; Kidney Diseases; Male; Melphalan; Multiple Myeloma; Myeloma Proteins; Prednisone; Proteinuria

Topics: Adult; Aged; Amyloid; Amyloidosis; Bence Jones Protein; Biopsy; Blood Protein Disorders; Electrophoresis; Female; Humans; Kidney Diseases; Male; Melphalan; Middle Aged; Proteinuria; Time Factors

Topics: Blood Urea Nitrogen; Creatinine; Cyclophosphamide; Humans; Immunoelectrophoresis; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Kidney Failure, Chronic; Male; Melphalan; Middle Aged; Multiple Myeloma; Proteinuria; Renal Dialysis

Topics: Acute Kidney Injury; Blood Proteins; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Paraplegia; Proteinuria; Renal Dialysis

Topics: Adult; Aged; Blood Platelets; Blood Proteins; Creatine; Female; Humans; Hypercalcemia; In Vitro Techniques; Leukocytes; Male; Melphalan; Middle Aged; Multiple Myeloma; Prednisone; Proteinuria

Topics: Blood Chemical Analysis; Blood Platelets; Blood Proteins; Blood Sedimentation; Calcium; Hemoglobinometry; Humans; Leukocyte Count; Melphalan; Multiple Myeloma; Neoplasms; Prognosis; Proteinuria; Toxicology

Topics: Alkylating Agents; Bence Jones Protein; Biomedical Research; Blood; Blood Protein Electrophoresis; Bone Marrow Examination; Calcium; Calcium, Dietary; Humans; Melphalan; Multiple Myeloma; Nitrogen; Proteinuria; Toxicology

Topics: Animals; Blood Protein Electrophoresis; Busulfan; Cyclophosphamide; Freund's Adjuvant; gamma-Globulins; Melphalan; Mice; Multiple Myeloma; Neoplasm Proteins; Neoplasms; Neoplasms, Experimental; Nitrogen Mustard Compounds; Pharmacology; Plasmacytoma; Proteinuria; Research; Staphylococcal Infections