Oral MP is the best therapy choice for this patient. Colchicine alone is inferior to MP, and adding colchicine to MP does not improve efficacy.2 Although hematologic improvement (ie, reduction in the monoclonal protein level) almost never results in immediate improvement in organ dysfunction caused by prior amyloid deposition, patients who have a sustained hematologic response are more likely to eventually have organ function improvement. VBMCP and other combination regimens do not improve response rates significantly but do add toxicity. Thalidomide is poorly tolerated at high doses because it can cause progressive edema, cognitive difficulties, and constipation as well as aggravate preexisting peripheral neuropathy.3
2. Kyle RA, Gertz MA, Greipp PR, et al. A trial of three regimens for primary amyloidosis: colchicine alone, melphalan and prednisone, and melphalan, prednisone, and colchicine. N Engl J Med 1997;336:1202-7.
3. Dispenzieri A, Lacy MQ, Rajkumar SV, et al. Poor tolerance to high doses of thalidomide in patients with primary systemic amyloidosis. Amyloid 2003;10:257-61.
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