Melphalan for Amyloidosis – pro

Treatment for systemic amyloidosis targets the aberrant plasma cell clone to prevent further synthesis and deposition of the amyloid protein. Conventional therapy usually combines oral melphalan with prednisone (MP), shown to yield higher response rates and longer survival than colchicine or prior therapies. This was investigated in a three arm study in 1997. The patients were randomly assigned to receive colchicine (72 patients), melphalan and prednisone (77), or melphalan, prednisone, and colchicine (71). They were stratified according to their chief clinical manifestations: renal disease (105 patients), cardiac involvement (46), peripheral neuropathy (19), or other (50). Therapy with melphalan and prednisone results in objective responses and prolonged survival as compared with colchicine in patients with primary amyloidosis. Guidelines on the diagnosis and management of AL amyloidosis. Br J Haematol 2004; 125:681–700.

Alastair Smith Finn Wisloff Diana Samson on behalf of the UK Myeloma Forum, Nordic Myeloma Study Group and British Committee for Standards in Haematology. (2006) Guidelines on the diagnosis and management of multiple myeloma 2005. British Journal of Haematology 132:4, 410-451

Wechalekar, A. D., Lachmann, H. J., Goodman, H. J. B., Bradwell, A., Hawkins, P. N., Gillmore, J. D. (2008). AL amyloidosis associated with IgM paraproteinemia: clinical profile and treatment outcome. Blood 112: 4009-4016

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