Multiple myelomaBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.d7953 (Published 05 January 2012) Cite this as: BMJ 2012;344:d7953
All rapid responses
Multiple myeloma’s more occult and more deadly relative
Myeloma might be easily missed, with symptoms passed off as due to osteoporosis or polymyalgia,1 but a more sinister direct relative may be hidden even further from view. Around 10-26% of patients with multiple myeloma will deposit light chains in extracellular tissues, in a relatively insoluble fibrillar matrix, forming AL amyloidosis.2-3
As in myeloma, AL amyloidosis is a systemic disease with many manifestations, but due to its relative rarity, the diagnosis is often missed. The lethality of AL amyloid deposition is undisputed, with a median survival of 10-14 months without treatment.4
It is worth mentioning that in both disease states the immunoglobulin light chains are inherently cytotoxic.5
1 Hsu DC, Wilkenfeld P, Joshua DE. Easily missed: Multiple myeloma. BMJ 2012;344:d7953.
2 Madin S, Dispenzieri A. Clinical features and treatment responses of light chain (AL) amyloidosis diagnosed in patients with a previous diagnosis of multiple myeloma. Mayo Clin Proc 2010;83(3):232-238.
3 Kyle RA, Bayrd ED. Amyloidosis: review of 236 cases. Medicine (Baltimore) 1975;54:271-299.
4 Skinner M, Anderson J, Simms R, et al. Treatment of 100 patients with primary amyloidosis: a randomized trial of melphalan, prednisone, and colchicine vs colchicine only. Am J Med 1996;100(3):290-298.
5 Liao R, Jain M, Teller P, Connors LH, Ngoy S, Skinner M, et al. Infusion of light chains from patients with cardiac amyloidosis causes diastolic dysfunction in isolated mouse hearts. Circulation 2001; 104(14):1594-7.
Competing interests: No competing interests