23 August 2021>: Articles
Hepatic AL Amyloidosis without Significant Light Chain Elevation in a Patient Treated with CyBorD Plus Daratumumab
Unusual clinical course, Rare disease
Brad Rybinski A* , Mehmet Kocoglu ADOI: 10.12659/AJCR.933241
Am J Case Rep 2021; 22:e933241
Table 2. Markers of hematological response. Light chains were never significantly elevated, and as the difference between involved (lambda) and uninvolved (kappa) light chains was never greater than 40 mg/L, hematological response could not be assessed by tracking light chains. Our patient always had a normal kappa/lambda ratio. Therefore, we assessed the hematological response by trending serum monoclonal protein, which declined with CyBorD, the addition of DARA, and then reached a nadir after stem cell transplant.
SPEP-IgG lambda monoclonal protein (g/dL) | Serum free light chains (mg/L): kappa/lambda | Kappa/lambda ratio | Difference between involved (lambda) and uninvolved (kappa) serum free light chains (mg/L) (dFLC) | |
---|---|---|---|---|
After liver biopsy showing amyloid, 10 days into admission | 0.63 | 12.11/15.81 | 0.77 | 3.7 |
While receiving cycle 1 of CyBorD, 1 month post discharge | 0.99 | 16.94/18.13 | 0.93 | 1.19 |
Status post CyBorD cycle 2 | 0.63 | 14.84/16.29 | 0.91 | 1.45 |
Status post CyBorD cycle 3 | 0.47 | 19.17/15.32 | 1.25 | −3.85 |
Status post CyBorD cycle 4+DARA cycle 1 | 0.31 | 10.20/9.88 | 1.03 | −0.32 |
Status post CyBorD cycle 5+DARA cycle 2 | 0.38 | 9.29/13.44 | 0.69 | 4.15 |
Status post CyBorD cycle 7+DARA cycle 4 | 0.27 | 7.85/11.29 | 0.70 | 3.44 |
Status post CyBorD cycle 8+DARA cycle 5 | 0.29 | 9.34/10.94 | 0.85 | 1.60 |
Induction stopped before ASCT | 0.37 | 9.91/12.35 | 0.80 | 2.44 |
Status post ASCT | 0.18 | 16.76/17.96 | 0.93 | 1.20 |
CyBorD – cyclophosphamide-bortezomib-dexamethasone; DARA – daratumumab; ASCT – autologous stem cell transplant. |