Successful management of refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis by vincristine adriamycin dexamethasone chemotherapy: a case report

Araoka, Toshikazu; Takeoka, Hiroya; Nishioka, Keisuke; Ikeda, Masaki; Kondo, Masayuki; Hoshina, Azusa; Kishi, Seiji; Araki, Makoto; Mimura, Rokuro; Murakami, Taichi; Mima, Akira; Nagai, Kojiro; Abe, Hideharu; Doi, Toshio

doi:10.1186/1752-1947-4-322

Cited by 3 publications

(5 citation statements)

References 16 publications

(24 reference statements)

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“…A total of 95 articles published over a period of 63 years were included, representing a final sample of 196 patients with PA. Figure 1 shows the flow chart of the article selection process. [ 8 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 <...…”

Section: Resultsmentioning

confidence: 99%

“…Response to treatment was defined as the total or partial control of PE or its symptoms. Only 31 (12.4%) patients showed good response to treatment (6 with the first treatment administered,[ 15 20 32 44 54 83 ] 14 with the second,[ 8 11 38 43 46 58 59 60 77 79 80 84 86 96 ] 6 with the third[ 10 47 51 63 78 ] and 5 with the fourth treatment administered[ 28 40 48 66 67 ]). Table 4 details the most frequent treatments or procedures (used in at least five cases).…”

Section: Resultsmentioning

confidence: 99%

“…[ 11 ] Other combination treatments were effective in 18 patients. [ 20 28 32 38 40 43 48 54 58 59 63 66 67 77 78 79 96 ] Indwelling pleural catheter (IPC), alone or associated with another treatment, was used in four patients, with a favorable response in three patients. [ 28 63 79 ]…”

Section: Resultsmentioning

confidence: 99%

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Characteristics of pleural effusion due to amyloidosis

Ferreiro¹,

Pou²,

Suárez-Antelo³

et al. 2023

Ann Thorac Med

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The characteristics of patients with pleural amyloidosis (PA) are poorly known. A systematic review was performed of studies reporting clinical findings, pleural fluid (PF) characteristics, and the most effective treatment of PA. Case descriptions and retrospective studies were included. The review included 95 studies with a total sample of 196 patients. The mean age was 63 years, male/female ratio was 1.6:1, and 91.9% of patients were >50 years. The most common symptom was dyspnea (88 patients). PF was generally serious (63%), predominantly lymphocytic, and with the biochemical characteristics of transudates (43.4%) or exudates (42.6%). Pleural effusion was generally bilateral (55%) and <1/3 of the hemithorax (50%), although in 21% pleural effusion (PE) exceeded 2/3. Pleural biopsy was performed in 67 patients (yield: 83.6%; 56/67) and was positive in 54% of exudates and 62.5% of unilateral effusions. Of the 251 treatments prescribed, only 31 were effective (12.4%). The combination of chemotherapy and corticosteroids was effective in 29.6% of cases, whereas talc pleurodesis was effective in 21.4% and indwelling pleural catheter in 75% of patients (only four patients). PA is more frequent in adults from 50 years of age. PF is usually bilateral, serous, and indistinctly a transudate or exudate. A pleural biopsy can aid in diagnosis if effusion is unilateral or an exudate. Treatments are rarely effective and there may be definitive therapeutic options for PE in these patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Characteristics of pleural effusion due to amyloidosis

Ferreiro¹,

Pou²,

Suárez-Antelo³

et al. 2023

Ann Thorac Med

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“…There have been two case reports that have explored other chemotherapeutic regimens that have had good results for systemic amyloidosis patients with pleural effusions. In one study, a patient who had previously been receiving intermittent melphalan and prednisone therapy for 7 years was treated with vincristine, adriamycin, and dexamethasone (VAD) therapy with prevention of recurrence of his pleural effusions for the six months that he was on treatment, with return of his pleural effusions only after cessation of therapy [ 18 ]. Ultimately, this patient underwent chemical pleurodesis and continued melphalan and prednisone therapy with no increase in his pleural effusions at four-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Pleural Effusions Occurring in Association with Primary Pulmonary Amyloidosis

Tada¹,

Anjum

Linville

et al. 2015

Case Reports in Pulmonology

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Recurrent pleural effusions occurring in association with immunoglobulin light chain amyloidosis and not associated with amyloid cardiomyopathy are rare. These portend an overall poor prognosis with mean survival time of approximately 1.8 months. We hereby report a case of a 59-year-old Caucasian female with recurrent pleural effusions and an ultimate diagnosis of pulmonary amyloidosis in association with plasma cell myeloma. The optimal treatment for recurrent pleural effusions in amyloidosis has not been determined; however, our patient responded to therapy with Cyclophosphamide-Bortezomib- (Velcade-) Dexamethasone (CyBorD) and had no repeat hospitalizations or recurrence of pleural effusion at four-month follow-up after initiation of therapy.

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“…Beschrieben sind Manifestationen im Rahmen einer AL-, einer AA-Amyloidose sowie einer Dialyse-assoziierten Amyloidose (ß2-Mikroglobulin als Amyloid-Vorläuferprotein) [56]. Die Behandlung der Grunderkrankung kann hier bereits zu einer deutlichen Befundbesserung beitragen [57,58]. Teils gehen die Pleuraergüsse mit Verschwartungen und Verkalkungen an der Pleura einher, die ebenfalls als Amyloidosemanifestationen zu werten sind.…”

Section: Pleuraergüsse Und Pleurale Raumforderungenunclassified

Amyloidose in der Pneumologie

et al. 2012

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Amyloidosis is a rare disorder within the field of pneumology, however, it is estimated that there are a relevant number of unreported cases. In routine clinical practice, the disease is seldom considered in the diagnostic work-up of unclear respiratory symptoms and radiological findings. For amyloidosis to be considered as a differential diagnosis, the clinician must be aware of the broad variety of its clinical manifestations. In cases where amyloidosis is suspected, it is important to obtain an early tissue biopsy. If the diagnosis can be confirmed by Congo red staining, further subtyping of the amyloid protein is necessary in order to identify a treatable cause of the disease. The amyloidoses are classified according to the type of amyloid protein, with clinical subclassifications distinguishing hereditary from acquired forms and localised from generalised manifestations. Apart from causal therapy of the primary disease, the treatment of generalised amyloidosis includes specific systemic therapy. The majority of localised forms are treated with specific local interventions showing good long-term results. This review outlines the pathophysiology, classification, diagnostic pathways and therapeutic modalities in amyloidosis. Furthermore, typical manifestations of amyloidosis of the lung and the specific treatment options are discussed.

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Successful management of refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis by vincristine adriamycin dexamethasone chemotherapy: a case report

Cited by 3 publications

References 16 publications

Characteristics of pleural effusion due to amyloidosis

Characteristics of pleural effusion due to amyloidosis

Recurrent Pleural Effusions Occurring in Association with Primary Pulmonary Amyloidosis

Amyloidose in der Pneumologie

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