Therapeutic Effects of Lenalidomide on Hemorrhagic Intestinal Myeloma-associated AL Amyloidosis

Abstract

A 74-year-old woman with refractory IgG-κ multiple myeloma developed massive melena caused by hemorrhagic submucosal tumors in the duodenum and middle jejunum. A biopsy revealed the tumor to be marked AL amyloid deposition. Treatment with bortezomib did not improve the melena or the underlying disease. The patient also developed multiple amyloidomas in the bilateral femoral heads, which caused a fracture in the left femoral head. Treatment with lenalidomide, as the final therapeutic option, resolved the intractable melena and improved both the intestinal lesions and myeloma. This case shows that successful treatment of multiple myeloma leads to marked improvement of accompanying AL amyloidosis.

AL Amyloidosis Complicated by Persistent Oral Bleeding

“…New therapy under investigation includes the immunomodulatory and antiangiogenic lenalidomide. In a recent study by Nagano et al, a patient with intractable melena in the setting of intestinal myeloma associated AL amyloidosis was noted to improve with lenalidomide as the curative treatment [ 16 ].…”

Multiple myeloma-associated skin light chain amyloidosis: A case of misdiagnosis

“…Recent novel agents, including lenalidomide, bortezomib and dexamethasone combination therapy, demonstrate favorable tolerability for this disease. It has been reported that MM-associated amyloidosis is an independent high-risk prognostic factor, while a similar 1-year survival rate (~80%) has been found in amyloid light-chain (AL) amyloidosis patients with or without concurrent myeloma ( 1 , 3 , 6 ). MM-associated amyloidosis has complex and diverse clinical manifestations.…”