Rapid reversal of nephrotic syndrome due to primary systemic AL amyloidosis after VAD and subsequent high-dose chemotherapy with autologous stem cellsupport

In a patient with nephrotic syndrome, renal biopsy revealed AL amyloid depo sits. Monoclonal lambda light chains were identified in serum and urine. A low percentage of monoclonal plasma cells was detected in the bone marrow. The patient received four cycles of VAD and subsequent high-dose chemothera py (HDCT) with melphalan (200 mg/m(2)) followed by autologous peripheral bl ood stem cell transplantation. Proteinuria rapidly diminished during chemot herapy. Three months after HDCT, the patient has no edema, and no signs of plasma cell dyscrasia are currently detectable. Using VAD before starting H DCT may improve the condition of patients with amyloidosis and reduce trans plantation-related morbidity and mortality.