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Autografting

High-dose melphalan and auto-SCT in patients with monoclonal Ig deposition disease

Bone Marrow Transplantation volume 42, pages 405–412 (2008)Cite this article

Abstract

The treatment of monoclonal Ig deposition disease (MIDD) is controversial and not standardized. We report our experience with high dose melphalan and auto-SCT (HDM/auto-SCT) in seven patients with MIDD associated with underlying Durie-Salmon stage IB multiple myeloma, including five with light chain deposition disease, one with light and heavy chain deposition disease and one with light chain crystal deposition disease. The median age of these patients was 50 years; six of them were male subjects. A monoclonal κ-light chain was detected by Serum Free Light Chain Assay in all seven. The patients received melphalan 140 mg/m2 followed by auto-SCT. All patients are alive and six remain in hematologic CR with a median follow up of 23.6 months (7.9–69.8 months). Renal function has improved compared to pre-HDSM/auto-SCT in five patients—two of whom had a renal transplant and became dialysis independent—remained stable in one and worsened in one leading to hemodialysis despite hematologic CR. Our results corroborate previous experience with HDM/auto-SCT in MIDD and argue in favor of kidney transplantation in patients who achieve hematologic CR after HDM/auto-SCT. Although this approach appears effective, multi-center studies are needed to define the optimal treatment for patients with MIDD.

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Acknowledgements

We thank the Memorial Sloan-Kettering Hematology-Oncology fellows and the nursing staff who helped us care for the patients on this study, and the members of the Clinical Trials Office who assisted us and especially the patients who participated. This work was supported by, the Graziano Fund, the Mel Stottlemyre Myeloma Research Fund, the Donald Stein Myeloma Research Fund and the Werner and Elaine Dannheiser Fund for Research on the Biology of Aging of the Lymphoma Foundation.

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Authors and Affiliations

  1. Division of Hematologic Oncology, Department of Medicine, Hematology Service, New York, NY, USA

    H Hassoun, B T Rafferty, A Cohen, V M Klimek, A Boruchov, T Kewalramani, L Reich, S D Nimer & R L Comenzo

  2. Department of Medicine, Nephrology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    C Flombaum

  3. Department of Pathology, Columbia University Medical Center, New York, NY, USA

    V D D'Agati

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  1. H Hassoun
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Correspondence to H Hassoun.

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Hassoun, H., Flombaum, C., D'Agati, V. et al. High-dose melphalan and auto-SCT in patients with monoclonal Ig deposition disease. Bone Marrow Transplant 42, 405–412 (2008). https://doi.org/10.1038/bmt.2008.179

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  • DOI: https://doi.org/10.1038/bmt.2008.179

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