Advertisement

AL (Immunoglobulin Light-Chain) Amyloidosis

  • Vaishali Sanchorawala
Part of the Contemporary Hematology book series (CH)

Introduction

The amyloidoses are a group of diseases that have in common the extracellular deposition of pathologic, insoluble fibrils in various tissues and organs. The fibrils have a characteristic beta-pleated sheet configuration that produces apple-green birefringence under polarized light when stained with Congo red dye. 1 Many different proteins can misfold and form amyloid fibrils, and the types of amy-loidosis are classified based on the amyloidogenic protein as well as by the distribution of amyloid deposits as either systemic or localized. 2 In the systemic amyloidoses, the amyloidogenic protein is produced at a site distant from the site of amyloid deposition. In contrast, in localized disease, the amyloidogenic protein is produced at the site of amyloid deposition (Table 1).
Table 1

Types of amyloidosis.

Disease

Precursor protein

Amyloid protein

 

Systemic disease

     

AL amyloidosis

Immunoglobulin light chain

AL

 

AA amyloidosis

Serum amyloid A (SAA)

AA

 

Familial...

Keywords

Multiple Myeloma Amyloid Deposit Amyloid Fibril Cardiac Amyloidosis Hematologic Response 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Merlini G, Bellotti V: Molecular mechanisms of amyloidosis. N Engl J Med 2003;349:583–596.PubMedCrossRefGoogle Scholar
  2. 2.
    Westermark P, Benson MD, Buxbaum JN, Cohen AS, Frangione B, Ikeda S, Masters CL, Merlini G, Saraiva MJ, Sipe JD: Amyloid: toward terminology clarification. Report from the Nomenclature Committee of the International Society of Amyloidosis. Amyloid 2005;12:1–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Gertz MA, Lacy MQ, Dispenzieri A: Amyloidosis. Hematol Oncol Clin North America 1999;13:1211–1220.CrossRefGoogle Scholar
  4. 4.
    Kyle RA, Linos A, Beard CM, Linke RP, Gertz MA, O'Fallon WM, Kurland LT: Incidence and natural history of primary systemic amyloidosis in Olmsted County, Minnesota, 1950 through 1989. Blood 1992;79:1817–1822.PubMedGoogle Scholar
  5. 5.
    Kyle RA, Gertz MA: Primary systemic amylodiosis: cClinical and laboratory features in 474 cases. Semin Hematol 1995;32:45–49.PubMedGoogle Scholar
  6. 6.
    Dember LM: Emerging treatment approaches for the systemic amyloidoses. Kidney Int 2005;68:1377–1390.PubMedCrossRefGoogle Scholar
  7. 7.
    Brenner DA, Jain M, Pimentel DR, Wang B, Connors LH, Skinner M, Apstein CS, Liao R: Human amyloidogenic light chains directly impair cardiomyocyte function through an increase in cellular oxidant stress. Circ Res 2004;94:1008–1010.PubMedCrossRefGoogle Scholar
  8. 8.
    Abraham RS, Ballman KV, Dispenzieri A, Grill DE, Manske MK, Price-Troska TL, Paz NG, Gertz MA, Fonseca R: Functional gene expression analysis of clonal plasma cells identifies a unique molecular profile for light chain amyloidosis. Blood 2005;105:794–803.PubMedCrossRefGoogle Scholar
  9. 9.
    Comenzo RL, Zhang Y, Martinez C, Osman K, Herrera GA: The tropism of organ involvement in primary systemic amyloidosis: contributions of Ig V(L) germ line gene use and clonal plasma cell burden. Blood 2001;98:714–720.PubMedCrossRefGoogle Scholar
  10. 10.
    Falk RH, Comenzo RL, Skinner M: The systemic amyloidoses. N Engl J Med 1997;337:898–909.PubMedCrossRefGoogle Scholar
  11. 11.
    Falk RH: Diagnosis and management of the cardiac amyloidoses. Circulation 2005;112:2047–2060.PubMedCrossRefGoogle Scholar
  12. 12.
    Park MA, Mueller PS, Kyle RA, Larson DR, Plevak MF, Gertz MA: Primary (AL) hepatic amyloidosis: clinical features and natural history in 98 patients. Medicine (Baltimore) 2003;82:291–298.CrossRefGoogle Scholar
  13. 13.
    Libbey CA, Skinner M, Cohen AS: Use of abdominal fat tissue aspirate in the diagnosis of systemic amyloidosis. Arch Intern Med 1983;143:1549–1552.PubMedCrossRefGoogle Scholar
  14. 14.
    Ansari-Lari MA, Ali SZ: Fine-needle aspiration of abdominal fat pad for amyloid detection: a clinically useful test? Diagn Cytopathol 2004;30:178–181.PubMedCrossRefGoogle Scholar
  15. 15.
    Abraham RS, Katzmann JA, Clark RJ, Bradwell AR, Kyle RA, Gertz MA: Quantitative analysis of serum free light chains. A new marker for the diagnostic evaluation of primary systemic amyloidosis. Am J Clin Pathol 2003;119:274–278.PubMedCrossRefGoogle Scholar
  16. 16.
    Katzmann JA, Clark RJ, Abraham RS, Bryant S, Lymp JF, Bradwell AR, Kyle RA: Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: relative sensitivity for detection of monoclonal light chains. Clin Chem 2002;48:1437–1444.PubMedGoogle Scholar
  17. 17.
    Katzmann JA, Abraham RS, Dispenzieri A, Lust JA, Kyle RA: Diagnostic performance of quantitative kappa and lambda free light chain assays in clinical practice. Clin Chem 2005;51:878–881.PubMedCrossRefGoogle Scholar
  18. 18.
    Akar H, Seldin DC, Magnani B, O''Hara C, Berk JL, Schoonmaker C, Cabral H, Dember LM, Sanchorawala V, Connors LH, Falk RH, Skinner M: Quantitative serum free light chain assay in the diagnostic evaluation of AL amyloidosis. Amyloid 2005;12:210–215.PubMedCrossRefGoogle Scholar
  19. 19.
    Swan N, Skinner M, O'Hara O'Hara CJ: Bone marrow core biopsy specimens in AL (primary) amyloidosis. A morphologic and immunohistochemical study of 100 cases. Am J Clin Pathol 2003;120:610–616.PubMedCrossRefGoogle Scholar
  20. 20.
    Sanchorawala V, Blanchard E, Seldin DC, O'Hara O'Hara C, Skinner M, Wright DG: AL amyloidosis associated with B-cell lymphoproliferative disorders: fFre-quency and treatment outcomes. Am J Hematol 2006.Google Scholar
  21. 21.
    Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Melton LJ, 3rd: Long-term follow-up of 241 patients with monoclonal gammopathy of undetermined significance: the original Mayo Clinic series 25 years later. Mayo Clin Proc 2004;79:859–866.PubMedCrossRefGoogle Scholar
  22. 22.
    Arbustini E, Verga L, Concardi M, Palladini G, Obici L, Merlini G: Electron and immuno-electron microscopy of abdominal fat identifies and characterizes amyloid fibrils in suspected cardiac amyloidosis. Amyloid 2002;9:108–114.PubMedGoogle Scholar
  23. 23.
    O'Hara CJ, Falk RH: The diagnosis and typing of cardiac amyloidosis. Amyloid 2003;10:127–129.PubMedCrossRefGoogle Scholar
  24. 24.
    Lachmann HJ, Booth DR, Booth SE, Bybee A, Gilbertson JA, Gillmore JD, Pepys MB, Hawkins PN: Misdiagnosis of hereditary amyloidosis as AL (primary) amy-loidosis. N Engl J Med 2002;346:1786–1791.PubMedCrossRefGoogle Scholar
  25. 25.
    Comenzo RL, Zhou P, Fleisher M, Clark B, Teruya-Feldstein J: Seeking confidence in the diagnosis of systemic AL (Ig light-chain) amyloidosis: patients can have both monoclonal gammopathies and hereditary amyloid proteins. Blood 2006;107:3489–3491.PubMedCrossRefGoogle Scholar
  26. 26.
    Falk RH, Lee VW, Rubinow A, Skinner M, Cohen AS: Cardiac technetium-99m pyro-phosphate scintigraphy in familial amyloidosis. Am J Cardiol 1984;54:1150–1151.PubMedCrossRefGoogle Scholar
  27. 27.
    Hawkins PN, Lavender JP, Pepys MB: Evaluation of systemic amyloidosis by scintigraphy with 123I-labeled serum amyloid P component. N Engl J Med 1990;323:508–513.PubMedCrossRefGoogle Scholar
  28. 28.
    Maceira AM, Joshi J, Prasad SK, Moon JC, Perugini E, Harding I, Sheppard MN, Poole-Wilson PA, Hawkins PN, Pennell DJ: Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation 2005;111:186–193.PubMedCrossRefGoogle Scholar
  29. 29.
    Perugini E, Rapezzi C, Piva T, Leone O, Bacchi-Reggiani L, Riva L, Salvi F, Lovato L, Branzi A, Fattori R: Non-invasive evaluation of the myocardial substrate of cardiac amyloidosis by gadolinium cardiac magnetic resonance. Heart 2006;92:343–349.PubMedCrossRefGoogle Scholar
  30. 30.
    Dispenzieri A, Gertz MA, Kyle RA, Lacy MQ, Burritt MF, Therneau TM, McCon-nell JP, Litzow MR, Gastineau DA, Tefferi A, Inwards DJ, Micallef IN, Ansell SM, Porrata LF, Elliott MA, Hogan WJ, Rajkumar SV, Fonseca R, Greipp PR, Witzig TE, Lust JA, Zeldenrust SR, Snow DS, Hayman SR, McGregor CG, Jaffe AS: Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood 2004;104:1881–1887.PubMedCrossRefGoogle Scholar
  31. 31.
    Palladini G, Campana C, Klersy C, Balduini A, Vadacca G, Perfetti V, Perlini S, Obici L, Ascari E, d'Eril GM, Moratti R, Merlini G: Serum N-terminal pro-brain natriuretic peptide is a sensitive marker of myocardial dysfunction in AL amyloido-sis. Circulation 2003;107:2440–2445.PubMedCrossRefGoogle Scholar
  32. 32.
    Palladini G, Lavatelli F, Russo P, Perlini S, Perfetti V, Bosoni T, Obici L, Bradwell AR, D'Eril D'Eril GM, Fogari R, Moratti R, Merlini G: Circulating amyloidog-enic free light chains and serum N-terminal natriuretic peptide type B decrease simultaneously in association with improvement of survival in AL. Blood 2006;107:3854–3858.PubMedCrossRefGoogle Scholar
  33. 33.
    Dispenzieri A, Lacy MQ, Katzmann JA, Rajkumar SV, Abraham RS, Hayman SR, Kumar SK, Clark R, Kyle RA, Litzow MR, Inwards DJ, Ansell SM, Micallef IM, Porrata LF, Elliott MA, Johnston PB, Greipp PR, Witzig TE, Zeldenrust SR, Russell SJ, Gastineau D, Gertz MA: Absolute values of immunoglobulin free light chains are prognostic in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplant. Blood 2006. 107:3378–3383.PubMedCrossRefGoogle Scholar
  34. 34.
    Gertz MA, Comenzo R, Falk RH, Fermand JP, Hazenberg BP, Hawkins PN, Merlini G, Moreau P, Ronco P, Sanchorawala V, Sezer O, Solomon A, Grateau G: Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis, Tours, France, 18–22 April 2004. Am J Hematol 2005;79:319–328.PubMedCrossRefGoogle Scholar
  35. 35.
    Skinner M, Sanchorawala V, Seldin DC, Dember LM, Falk RH, Berk JL, Anderson JJ, O'Hara O'Hara C, Finn KT, Libbey CA, Wiesman J, Quillen K, Swan N, Wright DG: High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: an 8-year study. Ann Intern Med 2004;140:85–93.PubMedGoogle Scholar
  36. 36.
    Seldin DC, Anderson JJ, Sanchorawala V, Malek K, Wright DG, Quillen K, Finn KT, Berk JL, Dember LM, Falk RH, Skinner M: Improvement in quality of life of patients with AL amyloidosis treated with high-dose melphalan and autologous stem cell transplantation. Blood 2004;104:1888–1893.PubMedCrossRefGoogle Scholar
  37. 37.
    Dember LM, Sanchorawala V, Seldin DC, Wright DG, LaValley M, Berk JL, Falk RH, Skinner M: Effect of dose-intensive intravenous melphalan and autologous blood stem-cell transplantation on al amyloidosis-associated renal disease. Ann Intern Med 2001;134:746–753.PubMedGoogle Scholar
  38. 38.
    Sanchorawala V, Seldin DC, Magnani B, Skinner M, Wright DG: Serum free light-chain responses after high-dose intravenous melphalan and autologous stem cell transplantation for AL (primary) amyloidosis. Bone Marrow Transplant 2005;36:597–600.PubMedCrossRefGoogle Scholar
  39. 39.
    Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Kumar S: Transplantation for amyloidosis. Curr Opin Oncol 2007;19:136–141.PubMedCrossRefGoogle Scholar
  40. 40.
    Mollee PN, Wechalekar AD, Pereira DL, Franke N, Reece D, Chen C, Stewart AK: Autologous stem cell transplantation in primary systemic amyloidosis: the impact of selection criteria on outcome. Bone Marrow Transplant 2004;33:271–277.PubMedCrossRefGoogle Scholar
  41. 41.
    Schonland SO, Perz JB, Hundemer M, Hegenbart U, Kristen AV, Hund E, Dengler TJ, Beimler J, Zeier M, Singer R, Linke RP, Ho AD, Goldschmidt H: Indications for high-dose chemotherapy with autologous stem cell support in patients with systemic amyloid light chain amyloidosis. Transplantation 2005;80:S160–S163.PubMedCrossRefGoogle Scholar
  42. 42.
    Chow LQ, Bahlis N, Russell J, Chaudhry A, Morris D, Brown C, Stewart DA: Autologous transplantation for primary systemic AL amyloidosis is feasible outside a major amyloidosis referral centre: the Calgary BMT Program experience. Bone Marrow Transplant 2005;36:591–596.PubMedCrossRefGoogle Scholar
  43. 43.
    Moreau P, Leblond V, Bourquelot P, Facon T, Huynh A, Caillot D, Hermine O, Attal M, Hamidou M, Nedellec G, Ferrant A, Audhuy B, Bataille R, Milpied N, Harous-seau JL: Prognostic factors for survival and response after high-dose therapy and autologous stem cell transplantation in systemic AL amyloidosis: a report on 21 patients. Br J Haematol 1998;101:766–769.PubMedCrossRefGoogle Scholar
  44. 44.
    Gertz MA, Blood E, Vesole DH, Abonour R, Lazarus HM, Greipp PR: A mul-ticenter phase 2 trial of stem cell transplantation for immunoglobulin light-chain amyloidosis (E4A97): an Eastern Cooperative Oncology Group Study. Bone Marrow Transplant 2004;34:149–154.PubMedCrossRefGoogle Scholar
  45. 45.
    Goodman HJ, Gillmore JD, Lachmann HJ, Wechalekar AD, Bradwell AR, Hawkins PN: Outcome of autologous stem cell transplantation for AL amyloidosis in the UK. Br J Haematol 2006;134:417–425.PubMedCrossRefGoogle Scholar
  46. 46.
    Vesole DH, Perez WS, Akasheh M, Boudreau C, Reece DE, Bredeson CN: High-dose therapy and autologous hematopoietic stem cell transplantation for patients with primary systemic amyloidosis: a Center for International Blood and Marrow Transplant Research Study. Mayo Clin Proc 2006;81:880–888.PubMedCrossRefGoogle Scholar
  47. 47.
    Dispenzieri A, Kyle RA, Lacy MQ, Therneau TM, Larson DR, Plevak MF, Raj-kumar SV, Fonseca R, Greipp PR, Witzig TE, Lust JA, Zeldenrust SR, Snow DS, Hayman SR, Litzow MR, Gastineau DA, Tefferi A, Inwards DJ, Micallef IN, Ansell SM, Porrata LF, Elliott MA, Gertz MA: Superior survival in primary systemic amy-loidosis patients undergoing peripheral blood stem cell transplantation: a case-control study. Blood 2004;103:3960–3963.PubMedCrossRefGoogle Scholar
  48. 48.
    Comenzo RL, Gertz MA: Autologous stem cell transplantation for primary systemic amyloidosis. Blood 2002;99:4276–4282.PubMedCrossRefGoogle Scholar
  49. 49.
    Perfetti V, Siena S, Palladini G, Bregni M, Di Nicola M, Obici L, Magni M, Bru-netti L, Gianni AM, Merlini G: Long-term results of a risk-adapted approach to melphalan conditioning in autologous peripheral blood stem cell transplantation for primary (AL) amyloidosis. Haematologica 2006;91:1635–1643.PubMedGoogle Scholar
  50. 50.
    Comenzo RL, Michelle D, LeBlanc M, Wally J, Zhang Y, Kica G, Karandish S, Arkin CF, Wright DG, Skinner M, McMannis J: Mobilized CD34 + cells selected as autografts in patients with primary light-chain amyloidosis: rationale and application. Transfusion 1998;38:60–69.PubMedCrossRefGoogle Scholar
  51. 51.
    Sanchorawala V, Wright DG, Seldin DC, Falk RH, Finn KT, Dember LM, Berk JL, Quillen K, Anderson JJ, Comenzo RL, Skinner M: High-dose intravenous mel-phalan and autologous stem cell transplantation as initial therapy or following two cycles of oral chemotherapy for the treatment of AL amyloidosis: results of a prospective randomized trial. Bone Marrow Transplant 2004;33:381–388.PubMedCrossRefGoogle Scholar
  52. 52.
    Gillmore JD, Goodman HJ, Lachmann HJ, Offer M, Wechalekar AD, Joshi J, Pepys MB, Hawkins PN: Sequential heart and autologous stem cell transplantation for systemic AL amyloidosis. In Blood. 2006:1227–1229.Google Scholar
  53. 53.
    Schonland SO, Lokhorst H, Buzyn A, Leblond V, Hegenbart U, Bandini G, Campbell A, Carreras E, Ferrant A, Grommisch L, Jacobs P, Kroger N, La Nasa G, Russell N, Zachee P, Goldschmidt H, Iacobelli S, Niederwieser D, Gahrton G: Allogeneic and syngeneic hematopoietic cell transplantation in patients with amyloid light-chain amyloidosis: a report from the European Group for Blood and Marrow Transplantation. Blood 2006;107:2578–2584.PubMedCrossRefGoogle Scholar
  54. 54.
    Skinner M, Anderson J, Simms R, Falk R, Wang M, Libbey C, Jones LA, Cohen AS: Treatment of 100 patients with primary amyloidosis: a randomized trial of melphalan, prednisone, and colchicine versus colchicine only. Am J Med 1996;100:290–298.PubMedCrossRefGoogle Scholar
  55. 55.
    Kyle RA, Gertz MA, Greipp PR, Witzig TE, Lust JA, Lacy MQ, Therneau TM: A trial of three regimens for primary amyloidosis: colchicine alone, melpha-lan and prednisone, and melphalan, prednisone, and colchicine. N Engl J Med 1997;336:1202–1207.PubMedCrossRefGoogle Scholar
  56. 56.
    Sanchorawala V, Wright DG, Seldin DC, Falk RH, Berk JL, Dember LM, Finn KT, Skinner M: Low-dose continuous oral melphalan for the treatment of primary systemic (AL) amyloidosis. Br J Haematol 2002;117:886–889.PubMedCrossRefGoogle Scholar
  57. 57.
    Perz JB, Schonland SO, Hundemer M, Kristen AV, Dengler TJ, Zeier M, Linke RP, Ho AD, Goldschmidt H: High-dose melphalan with autologous stem cell transplantation after VA D induction chemotherapy for treatment of amyloid light chain amyloidosis: a single centre prospective phase II study. Br J Haematol 2004;127:543–551.PubMedCrossRefGoogle Scholar
  58. 58.
    Dhodapkar MV, Hussein MA, Rasmussen E, Solomon A, Larson RA, Crowley JJ, Barlogie B: Clinical efficacy of high-dose dexamethasone with maintenance dex-amethasone/alpha interferon in patients with primary systemic amyloidosis: results of United States Intergroup Trial Southwest Oncology Group (SWOG) S9628. Blood 2004;104:3520–3526.PubMedCrossRefGoogle Scholar
  59. 59.
    Palladini G, Anesi E, Perfetti V, Obici L, Invernizzi R, Balduini C, Ascari E, Merlini G: A modified high-dose dexamethasone regimen for primary systemic (AL) amy-loidosis. Br J Haematol 2001;113:1044–1046.PubMedCrossRefGoogle Scholar
  60. 60.
    Palladini G, Perfetti V, Obici L, Caccialanza R, Semino A, Adami F, Cavallero G, Rustichelli R, Virga G, Merlini G: Association of melphalan and high-dose dexam-ethasone is effective and well tolerated in patients with AL (primary) amyloidosis who are ineligible for stem cell transplantation. Blood 2004;103:2936–2938.PubMedCrossRefGoogle Scholar
  61. 61.
    Seldin DC, Choufani EB, Dember LM, Wiesman JF, Berk JL, Falk RH, O'Hara O'Hara C, Fennessey S, Finn KT, Wright DG, Skinner M, Sanchorawala V: Toler-ability and efficacy of thalidomide for the treatment of patients with light chain-associated (AL) amyloidosis. Clin Lymphoma 2003;3:241–246.PubMedCrossRefGoogle Scholar
  62. 62.
    Dispenzieri A, Lacy MQ, Rajkumar SV, Geyer SM, Witzig TE, Fonseca R, Lust JA, Greipp PR, Kyle RA, Gertz MA: Poor tolerance to high doses of thalidomide in patients with primary systemic amyloidosis. Amyloid 2003;10:257–261.PubMedCrossRefGoogle Scholar
  63. 63.
    Palladini G, Perfetti V, Perlini S, Obici L, Lavatelli F, Caccialanza R, Invernizzi R, Comotti B, Merlini G: The combination of thalidomide and intermediate-dose dex-amethasone is an effective but toxic treatment for patients with primary amyloidosis (AL). Blood 2005;105:2949–2951.PubMedCrossRefGoogle Scholar
  64. 64.
    Wechalekar AD, Goodman HJ, Lachmann HJ, Offer M, Hawkins PN, Gillmore JD: Safety and efficacy of risk-adapted cyclophosphamide, thalidomide, and dexam-ethasone in systemic AL amyloidosis. Blood 2007;109:457–464.PubMedCrossRefGoogle Scholar
  65. 65.
    Sanchorawala V, Wright DG, Rosenzweig M, Finn KT, Fennessey S, Zeldis JB, Skinner M, Seldin DC: Lenalidomide and dexamethasone in the treatment of AL amyloidosis: results of a phase 2 trial. Blood 2007;109:492–496.PubMedCrossRefGoogle Scholar
  66. 66.
    Dispenzieri A, Lacy MQ, Zeldenrust SR, Hayman SR, Kumar SK, Geyer SM, Lust JA, Allred JB, Witzig TE, Rajkumar SV, Greipp PR, Russell SJ, Kabat B, Gertz MA: The activity of lenalidomide with or without dexamethasone in patients with primary systemic amyloidosis. Blood 2007;109:465–470.PubMedCrossRefGoogle Scholar
  67. 67.
    Gertz MA, Lacy MQ, Dispenzieri A, Cheson BD, Barlogie B, Kyle RA, Palladini G, Geyer SM, Merlini G: A multicenter phase II trial of 4¢′-iodo-4′₢deoxydoxorubicinde-oxydoxorubicin (IDOX) in primary amyloidosis (AL). Amyloid 2002;9:24–30.PubMedCrossRefGoogle Scholar
  68. 68.
    Gianni L, Bellotti V, Gianni AM, Merlini G: New drug therapy of amyloidoses: resorption of AL-type deposits with 4₢′-iodo-4₢′-deoxydoxorubicin. Blood 1995;86:855–861.PubMedGoogle Scholar
  69. 69.
    Pepys MB, Herbert J, Hutchinson WL, Tennent GA, Lachmann HJ, Gallimore JR, Lovat LB, Bartfai T, Alanine A, Hertel C, Hoffmann T, Jakob-Roetne R, Norcross RD, Kemp JA, Yamamura K, Suzuki M, Taylor GW, Murray S, Thompson D, Purvis A, Kolstoe S, Wood SP, Hawkins PN: Targeted pharmacological depletion of serum amyloid P component for treatment of human amyloidosis. Nature 2002;417:254–259.PubMedCrossRefGoogle Scholar
  70. 70.
    Hussein MA, Juturi J V, Rybicki L, Lutton S, Murphy BR, Karam MA: Etanercept therapy in patients with advanced primary amyloidosis. Med Oncol 2003;20:283–290.PubMedCrossRefGoogle Scholar
  71. 71.
    Hrncic R, Wall J, Wolfenbarger DA, Murphy CL, Schell M, Weiss DT, Solomon A: Antibody-mediated resolution of light chain-associated amyloid deposits. Am J Pathol 2000;157:1239–1246.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Vaishali Sanchorawala
    • 1
  1. 1.Boston University Medical CenterBostonUSA

Personalised recommendations