Journal
AMYLOID-JOURNAL OF PROTEIN FOLDING DISORDERS
Volume 10, Issue 4, Pages 250-256Publisher
TAYLOR & FRANCIS LTD
DOI: 10.3109/13506120309041742
Keywords
flow cytometry; plasma cell; AL amyloidosis; melphalan; autologous peripheral blood stem cell transplantation
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To investigate whether monoclonal plasma cells in the bone marrow are useful as a therapeutic marker in AL amyloidosis, serial flow cytometry was performed in five patients with this disorder before and after chemotherapy. Four patients were treated with 2 or 3 courses of VAD (vincristine, doxorubicin and dexamethazone) and subsequently with high-dose melphalan followed by auto-PBSCT The remaining one patient was treated with two courses of VAD alone. Before treatment all patients exhibited a CD19-CD56' subpopulation, which indicated monoclonal plasma cells, in varying degrees. After treatment all patients showed a decrease in monoclonal plasma cells in accordance with the disappearance of M-protein in serum and/or urine. In two patients treated with VAD followed by auto-PBSCT polyclonal (CD19(+)CD56(-)) and total plasma cells gradually increased in the follow-up study, while monoclonal plasma cells stayed at less than 0.3% nine months after treatment. No apparent correlation was found between altered maturation of plasma cells and disappearance of M-protein. With respect to easy detection of monoclonal plasma cells producing amyloidogenic M-protein, flow cytometry of bone marrow aspirates is useful and reliable in the follow-up of patients with AL amyloidosis and in the evaluation of the effects of chemotherapy.
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