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Amyloid light chain (AL) amyloidosis is a disorder of monoclonal plasma cells in which immunoglobulin light chains (M-proteins) form insoluble fibrils that accumulate in the heart, liver, kidneys, and peripheral nerves, causing major functional impairment. Median survival is <18 months. Treatments with agents usually used for multiple myeloma have had limited effectiveness because of the toxicity of these drugs in patients with baseline myocardial and renal dysfunction.
In a dose-escalation study, investigators evaluated bortezomib (Velcade), one of the newer agents for myeloma, in 31 patients with relapsed amyloidosis (61% male; median age, 59; 45% with kidney involvement; 19% with heart involvement). Starting doses of 0.7 to 1.6 mg/m2 week…