Kyle et al listed criteria for determining if a patient with primary systemic amyloidosis have responded to therapy. The authors are from the Mayo Clinic.
Conditions evaluated:
(1) nephrotic syndrome level proteinuria (>= 3 grams protein per 24 hour)
(2) liver involvement
(3) cardiac involvement
(4) serum albumin
(5) serum monoclonal protein
(6) urine monoclonal protein excretion
Conditions
Indications of Response
nephrotic syndrome level proteinuria
>= 50% reduction in proteinuria without an increase in serum creatinine (progres-sive renal insufficiency excluded)
liver involvement
decrease in extent by >= 2 cm; decrease in alkaline phosphatase by >= 50%
cardiac involvement
echocardiographic evidence of decrease in intervertebral septum >= 2 mm; increase in LVEF >= 20%
serum albumin
increase >= 1 g/dL from a pretreatment value < 3 g/dL and with stable renal function
serum monoclonal protein
disappearance or > 50% decrease
urine monoclonal protein excretion
disappearance or > 50% decrease
The decrease in liver involvement is probably in the midclavicular line.
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