P1: SBT
0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6
Amyloidosis 113➣calcium channel blockers, beta blockers and digoxin contraindi-
cated in cardiac amyloidosis
■diuretics useful
specific therapy
Primary Amyloidosis(AL)
■indicated for all patients with AL amyloid
■Treatment Options
■high-dose melphalan with autologous stem cell transplant
■melphalan-prednisone
■VAD (vincristine, doxorubicin, dexamethasone)
■thalidomide/dexamethasone
■Side Effects & Contraindications
■high-dose melphalan
➣side effects: mortality rate > 10%, myelosuppression, infectious
complications, organ toxicity
➣contraindications: poor performance status, uncontrolled heart
failure, active infections
■melphalan-prednisone
➣side effects: myelosuppression, myelodysplastic syndrome or
acute leukemia
➣contraindications: poor performance status, active infections
■VAD
➣side effects: myelosuppression, cardiac toxicity
➣contraindications: poor performance status, active infections
➣relative contraindication: based upon cardiac function
■Thalidomide/dexamethasone
➣side effects: peripheral neuropathy, constipation, fatigue
➣relative contraindications: peripheral neuropathy
Follow-Up
During Treatment
■chemotherapy should be performed by hematologist/oncologist
Routine
■assessment of cardiac function, renal function, etc based on organ
involvement and severity of disease
Complications & Prognosis
Complications
■progression of cardiac disease
■renal failure
■thrombotic events