Clinical study
Primary systemic amyloidosis. Comparison of melphalan/prednisone versus colchicine

https://doi.org/10.1016/0002-9343(85)90521-2Get rights and content

Abstract

This is the first prospectively randomized study of the use of melphalan/prednisone and colchicine in the treatment of primary systemic amyloidosis. One hundred one patients were stratified according to their dominant clinical manifestation. Forty-nine patients initially received melphalan/prednisone and eight subsequently had colchicine added to their regimen. Fifty-two patients initially received colchicine and 35 subsequently required melphalan/prednisone because of progressive disease. There was no difference in survival when the two groups were analyzed in aggregate (melphalan/prednisone, 25.2 months versus colchicine, 18 months; p = 0.23). When the survival of patients receiving only one regimen was analyzed or when survival was analyzed from the time of entry into the study to the time of death or progression of disease, significant differences (p <0.001 and p <0.0001, respectively) were evident, favoring melphalan/prednisone. This study suggests that melphalan/prednisone is superior to colchicine in the treatment of primary amyloidosis, but to confirm this impression, a study without a crossover group is necessary.

References (35)

  • GG Glenner et al.

    Amyloid fibril proteins: proof of homology with immunoglobulin light chains by sequence analyses

    Science

    (1971)
  • WD Terry et al.

    Structural identity of Bence Jones and amyloid fibril proteins in a patient with plasma cell dyscrasia and amyloidosis

    J Clin Invest

    (1973)
  • AS Cohen et al.

    Classification of amyloid: 1979–1980

    Arthritis Rheum

    (1980)
  • RA Kyle et al.

    “Primary” systemic amyloidosis and myeloma: discussion of relationship and review of 81 cases

    Arch Intern Med

    (1961)
  • HJ Cohen et al.

    Resolution of primary amyloidosis during chemotherapy: studies in a patient with nephrotic syndrome

    Ann Intern Med

    (1975)
  • MK Horne

    Improvement in amyloidosis (letter)

    Ann Intern Med

    (1975)
  • RS Schwartz et al.

    Therapy of primary amyloidosis with melphalan and prednisone

    Arch Intern Med

    (1979)
  • Cited by (148)

    • Treatment of AL Amyloidosis: Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Statement 2020 Update

      2021, Mayo Clinic Proceedings
      Citation Excerpt :

      Grade of Recommendation: A No trials have specifically addressed this point, but it is known through randomized trials that patients with AL treated with anti–plasma cell therapy live longer and can have clinical improvement compared with those who receive either no therapy or ineffective therapy like colchicine.85-88 Those patients who have monoclonal gammopathy of undetermined significance or smoldering myeloma with an incidental finding of a positive Congo red reaction of the bone marrow do not require therapy and have low risk of progression to vital organ involvement.

    • Treatment of Immunoglobulin Light Chain Amyloidosis Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Statement

      2015, Mayo Clinic Proceedings
      Citation Excerpt :

      Treatment should be initiated immediately in virtually all patients with systemic AL amyloidosis. No trials have been performed specifically to address this point, but it is known through randomized trials that patients with AL amyloidosis treated with chemotherapy live longer and can have clinical improvement compared with those who receive no therapy or ineffective therapy, such as colchicine.83-86 Patients who have monoclonal gammopathy of undetermined significance or asymptomatic myeloma with an incidental finding of a positive Congo red of the bone marrow do not require immediate chemotherapy.

    • Neurological complications in plasma cell dyscrasias

      2012, Handbook of Clinical Neurology
    View all citing articles on Scopus

    This work was supported in part by Research Grant CA-16835 from the National Institutes of Health, Public Health Service, Bethesda, Maryland, and by the Toor Myeloma Research Fund, West Palm Beach, Florida.

    View full text