Systemic Amyloidosis See Also Chapter

AL amyloidosis complicates the course of myeloma in 7-10% of patients.185 It is more commonly associated with myeloma of X light-chain type. Amyloidogenic light chains preferentially involve certain Vk and VA germline genes. The specific V gene is often associated with a propensity for a specific pattern of organ infiltration, suggesting an organ tropism of amyloidogenic light chain.86 87 Amyloid protein may deposit in many organs in the body.88 Serious organ dysfunctions develop when the kidneys, peripheral nervous system, and heart are involved. Cardiac amyloidosis results in arrhythmia, conduction defect, and restrictive cardiomyopathy. Involvement of the GI tract may produce mobility disorders and malabsorption. Pulmonary amyloidosis precipitates respiratory failure. Amyloid angiopathy causes spontaneous skin and mucosal bleeding. Amyloid may also deposit in the skin, endocrine organs, joints, and other tissues, occa sionally producing a pressure effect. Rarely, cortical bone involvement by amyloid results in pathologic fracture.

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