Light-chain deposition disease is a hematologic problem

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Aim. To analyze clinical and laboratory data and treatment results in patients with light-chain deposition disease (LCDD). Subjects and methods. Nine patients with LCDD and kidney injury were examined. The diagnosis was based on the results of light and immunofluorescence microscopy of renal biopsy specimens. All the patients received bortezomib, cyclophosphamide, and dexamethasone (VCD) induction therapy. Results. Six patients were diagnosed with multiple myeloma; in 3 patients LCDD was considered within monoclonal gammopathy manly involving the kidney. By the initiation of therapy, all the patients were diagnosed as having chronic kidney disease (Stage III (n=2), Stage IV (n=2), and dialysis-related renal failure (n=5)). After the VCD treatment, 7 of 9 patients achieved a hematologic response. Second-line therapy with lenalidomide proved to be effective in the other 2 cases. Five patients achieved complete remission; 3 had a very good partial remission. Thereafter, 2 patients received high-dose melphalan chemotherapy and autologous hematopoietic stem cell transplantation. Better renal function was noted in only 2 cases. Conclusion. Despite the high efficiency of therapy aimed to reduce monoclonal light chains; improved renal function was observed in only 2 (22%) patients. Such low rates of a renal response were due to the late initiation of therapy.

Keywords:

light-chain deposition disease

multiple myeloma

Authors:

Rekhtina I.G.

Gematologicheskiĭ nauchnyĭ tsentr Ministerstva zdravookhraneniia Rossii

Mendeleeva L.P.

GNTs Minzdrava Rossii, Moskva

Biriukova L.S.

Gematologicheskiĭ nauchnyĭ tsentr Ministerstva zdravookhraneniia Rossii

List of references:

Nasr SH, Valeri AM, Cornell LD, Fidler M, Sethi S, D'Agati V, Leung N. Renal monoclonal immunoglobulin deposition disease: a report of 64 patients from a single institution. Clin J Am Soci. 2012;7:231-239. doi:10.2215/CJN.08640811
2Leung N, Bridoux F, Hutchison CA, Nasr S, Cockwell P, Fermand J, Dispenzieri A, Song K, Kyle R. Monoclonal gammopathy of renal significance: when MGUS is no longer undetermined or insignificant. Blood. 2012;120(22):4292-4295. doi:10.1182/blood-2012-07-445304
3Pozzi C, Amigo DM, Fogazzi G, Curioni S, Ferrario F, Pasquali S, Quattrocchio G, Rollino C, Segagni S, Locatelli F. Light chain deposition disease with renal involvement: clinical characteristics and prognosis factors. Am J Kidney Dis. 2003;42(6):1154-1163. doi:10.1053/j.ajkd.2003.08.040
Ronco P, Plaisier E, Mougenot B, Aucouturier P. Immunoglobulin light (heavy)-chain deposition disease: from molecular medicine to pathophysiology-driven therapy. Clin J Am Soc Nephrol. 2006;1(6):1342-1350. doi:10.2215/CJN.01730506
Suzuki K. Light- and heavy-chain deposition disease (LHCDD): difficulty in diagnosis and treatment. Int. Med. 2005;44(9):915-916. doi:2169/internalmedicine.44.915
Gerth J, Sachse A, Busch M, Illner N, Muegge L, Gröne HJ, Wolf G. Screening and Differential Diagnosis of Renal Light Chain-Associated Diseases. Kidney Blood Press Res. 2012;35(2):120-128. doi:10.1159/000330715
Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV M, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson S, Caers J, Usmani S, Lahuerta J, Johnsen H, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle R, Anderson K, Durie B, Miguel J. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):538-548. doi:10.1016/S1470-2045(14)70442-5
Croitoru AG, Hytiroglou P, Schwartz ME, Saxena R. Liver transplantation for liver rupture due to light chain deposition disease: a case report. Semin Liver Dis. 2006;26(3):298-303. doi:10.1055/s-2006-947301
Popovic M, Tavcar R, Glavac D, Volavsek M, Pirtosek Z, Vizjak A. Light chain deposition disease restricted to the brain: The first case report. Human Pathol. 2007;38(1):179-184. doi:10.1016/j.humpath.2006.07.010
Toor AA, Ramdane BA, Joseph J, Thomas M, O’Hara C, Barlogie B, Walker P, Joseph L. Cardiac nonamyloidotic immunoglobulin deposition disease. . Mod Pathol. 2006;19(2):233-237. doi:10.1038/modpathol.3800524
Michopoulos S, Petraki K, Petraki C, Dimopoulos MA. Light chain deposition disease of the liver without renal involvement in a patient with multiple myeloma related to liver failure and rapid fatal outcome. Dig Dis Sci. 2002;47:730-734.
Teng J, Turbat-Herrera EA, Herrera GA. Role of translational research advancing the understanding of the pathogenesis of light chain-mediated glomerulopathies. Pathology Internationa. 2007; 57(7):398-412. doi:10.1111/j.1440-1827.2007.02116
Gokden N, Barlogie B, Liapis H. Morphologic heterogeneity of renal light-chain deposition disease. Ulrtastruct Pathol. 2008;32(1):7-24. doi:10.1080/01913120701854002
Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR. Review of 1,027 patients with newly diagnosed mul-tiple myeloma. Mayo Clin Proc. 2003;78:21-33. doi:10.4065/78.1.21
Rekhtina I, Mendeleeva L, Biriukova L. Dialysis-dependent renal failure in patients with multiple myeloma: Reversibility factors. Terapevticheskii arkhiv. 2015;87(7):72-76. (In Russ.) doi:10.17116/terarkh201587772-76
Lin J, Markowitz GS, Valeri AM, Kambham N, Sherman WH, Appel GB, D'Agati VD. Renal monoclonal immunoglobulin deposition disease: The disease spectrum. J Am Soc Nephrol. 2001;12(7):1482-1492.
Fermand J-P, Bridoux F, Kyle RA, Kastritis E, Weiss BM, Cook MA, Drayson MT, Dispenzieri A, Leung N. on behalf of the International Kidney and Monoclonal Gammopathy Research Group . How I treat monoclonal gammopathy of renal significance (MGRS). Blood. 2013;122(22):3583-3590. doi:10.1182/blood-2013-05-495929
Jimenez-Zepeda V H, Trudel S, Winter A, Reece D E, Chen C, Kukreti V. Autologous stem cell transplant for light chain deposition disease: Incorporating bortezomib to the induction therapy. Am J Hematol. 2012;87(8):822-823. doi:10.1002/ajh.23235
Bansal T, Hossain R, Mckane W, Snowden JA. Safety and efficacy of high dose melphalan and autologous stem cell transplantation prior to renal allograft in end-stage renal failure secondary to Monoclonal Immunoglobulin Deposition Disease. Cell Ther Transplant. 2011;3(10):1-4. doi:10.3205/ctt-2011-en-000091.01
Gertz MA. Managing light chain deposition disease. Leuk Lymph. 2012;53(2):183-184. doi:10.3109/10428194.2011.622423.
Leung N, Lager DJ, Gertz MA, Wilson K, Kanakiriya S., Fervenza F. . Long-term outcome of renal transplantation in light chain deposition disease. Am J Kidney Dis. 2004;43:147-153. doi:1053/j.ajkd.2003.09.020
Weichman K, Dember L, Prokaeva T, Wright D, Quillen K, Rosenzweig M, Skinner M, Seldin D, Sanchorawala V. Clinical and molecular characteristics of patients with non-amyloid light chain deposition disorders, and outcome following treatment with high-dose melphalan and autologous stem cell transplantation. Bone Marrow Transplant. 2006;38(5):339-343. doi:10.1038/sj.bmt.1705447
Telio D, Shepherd J, Forrest D, Zypchen L, Barnett M, Nevill T, Song KW. High-dose melphalan followed by ASCT has favorable safety and efficacy in selected patients with light chain deposition disease and light and heavy chain deposition disease. Bone Marrow Transplant. 2012;47:453-455. doi:10.1038/bmt.2011.87
Cohen C, Royer B, Javaugue V, Szalat R, Karoui K, Caulier A, Knebelmann B, Jaccard A, Chevret S, Touchard G, Fermand J, Arnulf B, Bridoux F. Bortezomib produces high hematological response rates with prolonged renal survival in monoclonal immunoglobulin deposition disease. Kidney Int. 2015;88(5):1135-1143. doi:10.1038/ki.2015.201
Royer B, Arnulf B, Martinez F, Roy L, Flageul B, Etienne I, Ronco P, Brouet J, Fermand J. High dose chemotherapy in light chain or light and heavy chain deposition disease. Kidney Int. 2004;65(2):642-648. doi:10.1111/j.1523-1755.2004.00427
Harada K, Akai Y, Sakan H, Yamaguchi Y, Nakatani K, Iwano M, Saito Y. Resolution of mesangial light chain deposits 3 years after high- dose melphalan with autologous peripheral blood stem cell transplantation. Clin Nephrol. 2010;74(5):384-388. doi:10.2379/CNX06365 doi:10.2379/CNX06365

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