Surgical removal of amyloid-laden lymph nodes: a possible therapeutic approach in a primary systemic AL amyloidosis patient with focal lymphadenopathy

Abstract

We report a patient with primary systemic AL amyloidosis who suffered from remarkable bilateral cervical lymphadenopathy. Intensive chemotherapies, including two cycles of high-dose melphalan with autologous peripheral blood stem cell transplantation, were insufficiently effective for both the lymphadenopathy and amyloidogenic IgGλ-type M-protein in serum, but the patient showed complete haematological remission after extensive surgical removal of enlarged lymph nodes that had massive depositions of λ-type immunoglobulin light chain-derived amyloid. Lymphadenectomy may be a possible therapeutic approach with regard to both cosmetic and haematological aspects in primary systemic AL amyloidosis patients with focal lymphadenopathy.

Keywords:

• Lymphadenopathy
• primary systemic AL amyloidosis
• lymphadenectomy
• high-dose melphalan
• autologous peripheral blood stem cell transplantation

Abbreviations
FLCs	=	free light chains
HDM/SCT	=	high-dose melphalan with autologous peripheral blood stem cell transplantation
VAD	=	vincristine, doxorubicin and dexamethasone

Abbreviations
FLCs	=	free light chains
HDM/SCT	=	high-dose melphalan with autologous peripheral blood stem cell transplantation
VAD	=	vincristine, doxorubicin and dexamethasone

Acknowledgment

This work was supported by a grant from the Intractable Disease Division, the Ministry of Health and Welfare, Amyloidosis Research Committee in Japan.

Declaration of interest:

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.