Induction treatment of light chain deposition disease with bortezomib: rapid hematological response with persistence of renal involvement

Light-Chain Deposition Disease Successfully Treated with Bortezomib in an Elderly Patient: A Case Report and Review of the Literature

“…Besides directly reducing LC burden, there are several reports to indicate that bortezomib may also have a renoprotective effect (11)(12)(13). In the setting of LCDD, nuclear factor kappa B (NF-κB), activated in proximal tubules and glomerular mesangial cells, plays a pivotal role.…”

“…NF-κB is known to induce platelet-derived growth factor-β and tumor growth factor-β (TGF-β), thus leading to cellular proliferation and collagen production. Bortezomib has been suggested to inhibit NF-κB, thereby decreasing TGF-β levels and collagen production, eventually preventing glomerulosclerosis and renal dysfunction (11)(12)(13). Furthermore, several case reports have already shown that bortezomib stabilizes the renal function in patients with LCDD without serious adverse effects (19)(20)(21)(22)(23)(24).…”

“…Recently, the combined administration of bortezomib and dexamethasone has shown clinical activity in MM patients, even those with ESRD who are undergoing dialysis (9,10). Furthermore, promising results have been reported in LCDD patients (11)(12)(13). Bortezomib, a reversible proteasome inhibitor, leads to apoptosis of the malignant plasma cells that show abnormal proliferation and consequently, reduces LC burden (9,10).…”

Light Chain Deposition Disease in an Older Adult Patient Successfully Treated with Long-term Administration of Bortezomib, Melphalan and Prednisone

“…Similar results have been reported among LCDD patients. Table shows a list of previous reports describing patients with LCDD who received bortezomib-based regimens without high-dose chemotherapy (11,14,15). The patient described here showed an abrupt elevation in the serum levels of hepatobiliary enzymes after the first cycle of the VCD regimen.…”

“…The patients' age and extra-renal manifestations, especially cardiac involvement, are associated with complications and death after autologous stem cell transplantation (3). Another report showed that intensive chemotherapy was more toxic in patients with LCDD compared with those with multiple myeloma (11). Thus, patients should be carefully assessed before such aggressive treatment is administered.…”