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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 A

DOI: 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/lambdaKappa/lambda ratioDifference between involved (lambda) and uninvolved (kappa) serum free light chains (mg/L) (dFLC)
After liver biopsy showing amyloid, 10 days into admission0.6312.11/15.810.773.7
While receiving cycle 1 of CyBorD, 1 month post discharge0.9916.94/18.130.931.19
Status post CyBorD cycle 20.6314.84/16.290.911.45
Status post CyBorD cycle 30.4719.17/15.321.25−3.85
Status post CyBorD cycle 4+DARA cycle 10.3110.20/9.881.03−0.32
Status post CyBorD cycle 5+DARA cycle 20.389.29/13.440.694.15
Status post CyBorD cycle 7+DARA cycle 40.277.85/11.290.703.44
Status post CyBorD cycle 8+DARA cycle 50.299.34/10.940.851.60
Induction stopped before ASCT0.379.91/12.350.802.44
Status post ASCT0.1816.76/17.960.931.20
CyBorD – cyclophosphamide-bortezomib-dexamethasone; DARA – daratumumab; ASCT – autologous stem cell transplant.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923