Serum Levels of Free Light Chain before and after Chemotherapy in Primary Systemic AL Amyloidosis

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概要

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• Objective Immunoglobulin-related free light chains (FLCs) in serum have recently become quantitatively detectable using the nephelometric assay in plasma cell disorders, including multiple myeloma and AL amyloidosis. To investigate whether FLCs are useful as a diagnostic and therapeutic marker in Japanese patients with primary systemic AL amyloidosis, we determined these values in serum before and after chemotherapy.Patients and Methods The serum FLC analysis was carried out in 25 patients with primary systemic AL amyloidosis (mean age, 60.1±8.4 years). All of the patients were shown to have either ALê- or ALë-immunoreactive amyloid deposits on biopsied tissues. Thirteen patients were treated with VAD (vincristine, doxorubicin and dexamethasone) alone (n=6) or VAD and subsequent high-dose melphalan followed by autologous stem cell support (n=7), and serum FLCs were serially determined before and after the chemotherapy.Results Before chemotherapy the amyloidogenic FLC was elevated in serum with or without abnormal ê/ë ratios in 24 patients, including 5 with undetectable M-protein in both serum and urine on immunofixation. After chemotherapy the amyloidogenic FLC in serum was significantly decreased irrespective of high-dose melphalan (p<0.05), and all the patients with normalized ê/ë ratios showed a good prognosis.Conclusions With respect to sensitivity and quantification serum FLCs will be a key marker for diagnosis and therapeutic effects in primary systemic AL amyloidosis. The prognosis of patients with this disease may be improved if the ê/ë ratio in serum can be normalized by intensive chemotherapy.

• 社団法人　日本内科学会の論文
• 2005-05-01

著者

• 山田 俊幸

  自治医科大学臨床検査医学講座

• 山田 俊幸

  順天堂大学 医学部小児科

• 山田 俊幸

  自治医科大学医学部 臨床検査医学

• YAMADA Toshiyuki

  Department of Clinical Laboratory Medicine, Jichi Medical University

• MATSUDA Masayuki

  Third Department of Medicine, Shinshu University School of Medicine

• GONO Takahisa

  Third Department of Medicine, Shinshu University School of Medicine

• SHIMOJIMA Yasuhiro

  Third Department of Medicine, Shinshu University School of Medicine

• ISHII Wataru

  Third Department of Medicine, Shinshu University School of Medicine

• FUSHIMI Tomohisa

  Third Department of Medicine, Shinshu University School of Medicine

• SAKASHITA Kazuo

  Department of Pediatrics, Shinshu University School of Medicine

• KOIKE Kenichi

  Department of Pediatrics, Shinshu University School of Medicine

• IKEDA Shu-ichi

  Third Department of Medicine, Shinshu University School of Medicine

• 山田 俊幸

  順天堂大学医学部臨床病理学教室

• 山田 俊幸

  順天堂大学医学部臨床病理

• 山田 俊幸

  自治医科大学臨床検査医学

• Koike Kenichi

  Department Of Pediatrics Shinshu University School Of Medicine

• Koike Kenichi

  The Department Of Pediatrics Shinshu University School Of Medicine

• 山田 俊幸

  順天堂大学医学部臨床病理学

• Sakashita Kazuo

  Department Of Pediatrics Shinshu University School Of Medicine

• Sakashita Kazuo

  The Department Of Pediatrics Shinshu University School Of Medicine

• Yamada Toshiyuki

  Department Of Biochemistry And Genome Biology Hirosaki University Graduate School Of Medicine

• Ikeda Shuichi

  The Third Department Of Medicine Shinshu University School Of Medicine

• Matsuda Masayuki

  Third Department Of Medicine Shinshu University School Of Medicine

• Ikeda Shu-ichi

  Third Department Of Medicine Shinshu University School Of Medicine

• Ikeda Shu-ichi

  Department Of Neurology Shinshu University School Of Medicine

• Ishii Wataru

  The Third Department Of Medicine Shinshu University School Of Medicine

• Sekijima Yoshiki

  The Third Department Of Medicine Shinshu University School Of Medicine

• Shimojima Yoshio

  Third Department Of Medicine Shinshu University School Of Medicine

• Matsuda Masayuki

  The Third Department Of Medicine Shinshu University School Of Medicine

• Ikeda Shu-ihci

  Dep. Of Medicine (neurology And Rheumatology) Shinshu Univ. School Of Medicine

• Shimojima Yasuhiro

  Third Department Of Medicine (neurology And Rheumatology) Shinshu University School Of Medicine

• Ikeda Shu-ichi

  Third Department Of Medicine (neurology And Rheumatology) Shinshu University School Of Medicine

• Matsuda Masayuki

  Third Department Of Medicine (neurology And Rheumatology) Shinshu University School Of Medicine

• Yamada Toshiyuki

  Department Of Applied Physics Faculty Of Engineering University Of Tokyo:(present Address) Sony Corp

• Ishii Wataru

  Third Department Of Medicine (neurology And Rheumatology) Shinshu University School Of Medicine

• Ikeda Shu-ichi

  Third Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine

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