Figure 340

Survival curves in patients with primary systemic amyloidosis. Because amyloid fibrils consist of monoclonal immunoglobulin light chains, treatment with alkylating agents that are effective against plasma cell neoplasms is warranted. We treated 220 patients who had positive results on biopsy. The patients were randomized to receive colchicine (C, 72 patients), melphalan and prednisone (MP, 77), or melphalan, prednisone, and colchicine (MPC, 71). Patients were stratified according to their chief clinical manifestations: renal disease (105 patients), cardiac involvement (46), peripheral neuropathy (19), or other (50). The median duration of survival after randomization was 8.5 months in the colchicine group; 18 months in the group assigned to melphalan and prednisone; and 17 months in the group assigned to melphalan, prednisone, and colchicine (P < 0.001). In patients who had a reduction in serum or urine monoclonal protein at 12 months, the overall duration of survival was 50 months; whereas among those without a reduction in monoclonal protein at 12 months, the duration of survival was 36 months (P < 0.003). Thirty-four patients (15%) survived for 5 years or longer. (Adapted from Kyle et al. [12]; with permission.)

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