AL amyloidosis is a plasma cell disorder in which tissue deposition of immunoglobulin light chains leads to organ dysfunction. Recent reports of high-dose therapy with autologous stem cell transplantation for amyloidosis suggest higher response rates and extended survival compared to those seen with conventional chemotherapy. However, substantial treatment-related toxicity has been observed. This case series describes our institutional experience with autologous transplantation in four patients with amyloidosis with an emphasis on unique gastrointestinal toxicities, including toxic megacolon.
This is a preview of subscription content, access via your institution
Subscribe to Journal
Get full journal access for 1 year
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Kyle RA, Gertz MA . Primary systemic amyloidosis: clinical and laboratory features in 474 cases Semin Hematol 1995 32: 45 59
Skinner M, Anderson J, Simms R et al. 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
Kyle RA, Gertz MA, Greipp PR et al. A trial of three regimens for primary amyloidosis: colchicine alone, melphalan and prednisone, and melphalan, prednisone, and colchicine New Engl J Med 1997 336: 1202 1207
Amoura Z, Leblond V, Azar N et al. High dose therapy and autologous stem cell transplantation (ASCT) for systemic amyloidosis (AL): report of 9 cases (abstract) Arthritis Rheum 1998 41: S234
Moreau P, Leblond V, Bourquelot P et al. 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
Lokhorst HM, Verdonck LF . Intensive therapy in AL amyloidosis and light-chain deposition disease (letter) Ann Intern Med 1995 123: 553
Comenzo RL, Falk RH, Sanchorawala V et al. Treating AL amyloidosis (AL) with dose-intensive melphalan: outcomes in 102 patients Blood 1998 92: 324a
Gertz MA, Lacy MQ, Dispenzieri A . Myeloablative chemotherapy with stem cell rescue for the treatment of primary systemic amyloidosis: a status report Bone Marrow Transplant 2000 25: 465 470
Dember LM, Sanchorawala V, Seldin DC et al. 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
Gertz MA, Lacy MQ, Gastineau DA et al. Blood stem cell transplantation as therapy for primary systemic amyloidosis (AL) Bone Marrow Transplant 2000 26: 963 969
Sanchorawala V, Wright DG, Seldin DC et al. An overview of the use of high-dose melphalan with autologous stem cell transplantation for the treatment of AL amyloidosis Bone Marrow Transplant 2001 28: 637 642
Comenzo RL, Vosburgh E, Falk RH et al. Dose-intensive melphalan with blood stem-cell support for the treatment of AL (amyloid light-chain) amyloidosis: survival and responses in 25 patients Blood 1998 91: 3662 3670
Reich G, Held T, Siegert W et al. Four patients with AL amyloidosis treated with high-dose chemotherapy and autologous stem cell transplantation Bone Marrow Transplant 2001 27: 341 343
Moreau P, Milpied N, de Faucal P et al. High-dose melphalan and autologous bone marrow transplantation for systemic AL amyloidosis with cardiac involvement Blood 1996 87: 3063 3064
Patriarca F, Geromin A, Fanin R et al. Improvement of amyloid-related symptoms after autologous stem cell transplantation in a patient with hepatomegaly, macroglossia and purpura Bone Marrow Transplant 1999 24: 433 435
Sezer O, Schmid P, Shweigert M et al. Rapid reversal of nephrotic syndrome due to primary systemic AL amyloidosis after VAD and subsequent high-dose chemotherapy with autologous stem cell support Bone Marrow Transplant 1999 23: 967 969
Anonymous. National Cancer Institute Common Toxicity Criteria. version 2.0 April 30 1999
Tzung SP, Hackman RC, Hockenbery DM et al. Lymphocytic gastritis resembling graft-vs.-host disease following autologous hematopoietic cell transplantation Biol Blood Marrow Transplant 1998 4: 43 48
Moreau P . Autologous stem cell transplantation for AL amyloidosis: a standard therapy? Leukemia 1999 13: 1929 1931
Majolino I, Vignetti M, Meloni G et al. Autologous transplantation in multiple myeloma: a GITMO retrospective analysis on 290 patients. Gruppo Italiano Trapianti di Midollo Osseo Haematologica 1999 84: 844 852
Attal M, Harousseau JL, Stoppa AM et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome New Engl J Med 1996 335: 91 97
Mehta J, Nagler A, Slavin S . Marrow transplantation in multiple myeloma New Engl J Med 1992 326: 1087 discussion 1087 1088
Schulenburg A, Kalhs P, Oberhuber G et al. Gastrointestinal perforation early after peripheral blood stem cell transplantation for AL amyloidosis Bone Marrow Transplant 1998 22: 293 295
Comenzo RL . Hematopoietic cell transplantation for primary systemic amyloidosis: what have we learned Leuk Lymphoma 2000 37: 245 258
Sheth SG, LaMont JT . Toxic megacolon Lancet 1998 351: 509 513
Carlson HC, Breen JF . Amyloidosis and plasma cell dyscrasias: gastrointestinal involvement Semin Roentgenol 1986 21: 128 138
Kyle RA, Greipp PR, O'Fallon WM . Primary systemic amyloidosis: multivariate analysis for prognostic factors in 168 cases Blood 1986 68: 220 224
Chabner BA, Longo DL . Cancer Chemotherapy and Biotherapy. 3rd edn Lippincott Williams and Wilkins: Philadelphia 2001
Saba N, Sutton D, Ross H et al. High treatment-related mortality in cardiac amyloid patients undergoing autologous stem cell transplant Bone Marrow Transplant 1999 24: 853 855
Desikan KR, Dhodapkar MV, Hough A et al. Incidence and impact of light chain associated (AL) amyloidosis on the prognosis of patients with multiple myeloma treated with autologous transplantation Leuk Lymphoma 1997 27: 315 319
Dispenzieri A, Lacy MQ, Kyle RA et al. Eligibility for hematopoietic stem-cell transplantation for primary systemic amyloidosis is a favorable prognostic factor for survival J Clin Oncol 2001 19: 3350 3356
Majolino I, Marceno R, Pecoraro G et al. Autologous stem cell transplantation in amyloidosis AL Bone Marrow Transplant 1993 11: 85
van Buren M, Hene RJ, Verdonck LF et al. Clinical remission after syngeneic bone marrow transplantation in a patient with AL amyloidosis Ann Intern Med 1995 122: 508 510
Gillmore JD, Hawkins PN, Pepys MB . Amyloidosis: a review of recent diagnostic and therapeutic developments Br J Haematol 1997 99: 245 256
We thank the staff of the Adult Bone Marrow Transplantation Program at Oregon Health and Sciences University, particularly coordinators Anne Kratz, RN and Florence Seelig, RN.
About this article
Cite this article
Hayes-Lattin, B., Curtin, P., Fleming, W. et al. Toxic megacolon: a life-threatening complication of high-dose therapy and autologous stem cell transplantation among patients with AL amyloidosis. Bone Marrow Transplant 30, 279–285 (2002). https://doi.org/10.1038/sj.bmt.1703627
- AL amyloidosis
- high-dose chemotherapy
- stem cell transplantation
- toxic megacolon