J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Case Report

Volume 7, Number 10, October 2015, pages 807-811

Lenalidomide Desensitization in Systemic Light-Chain Amyloidosis With Multi-Organ Involvement

Figures

Figure 1. Combined results of troponin and BNP throughout the course of treatment.

Figure 2. Free kappa and lambda during the course of chemotherapy.

Tables

**Table 1.** Hematological Responses of Our Patient at Various Stages of Treatments Based on Girnius S. Seldin DC. JCO. 2013
Chemotherapy	Date	Kappa	Lamda	K/L	dFLC	Hematological response
Mel + dex July 7, 2009 - March 16, 2010	July 7, 2009	657	27.3	24.07	629.7	PR
Mel + dex July 7, 2009 - March 16, 2010	March 16, 2010	65.6	17.1	3.84	48.5	PR
Bortezomib July 27, 2010 - May 24, 2011	July 27, 2010	133	23.5	5.66	109.5	VGPR
Bortezomib July 27, 2010 - May 24, 2011	April 12, 2011	27.3	9.6	2.84	17.7	VGPR
Lenalidomide October 15, 2013 - April 19, 2014	October 15, 2013	309.9	59.3	5.23	250.6	PR
Lenalidomide October 15, 2013 - April 19, 2014	January 7, 2014	173.1	77.6	2.23	95.5	PR

**Table 2.** Incremental Increase in Lenalidomide Dosing for Desensitization and Patient Vitals Monitoring Table
Dose#	Stock solution concentrations	Dose (mg)	Amount given (mL) by mouth	Time the dose given	BP (mm Hg)	HR per min	RR per min	Temp (°C)	O₂ Sat (%)
Baseline				14:00	104/66	69	16	36.6	97
1	Solution D (0.001 mg/mL)	0.00025 mg	0.25	14:15	105/66	70	16	36.9	98
2		0.00125 mg	1.25	14:30	103/64	71	16	36.5	98
3		0.0025 mg	2.5	14:45	104/65	71	16	36.8	98
4	Solution C (0.01 mg/mL)	0.0125 mg	1.25	15:00	102/62	70	16	36.9	98
5		0.025 mg	2.5	15:15	101/62	71	16	37.0	99
6	Solution B (0.1 mg/mL)	0.125 mg	1.25	15:32	117/74	72	16	36.7	100
7		0.25 mg	2.5	15:45	106/69	72	16	37.1	100
8		0.5 mg	5	16:00	104/67	72	16	37.0	100
9	Solution A (1 mg/mL)	0.75 mg	0.75	16:15	105/66	72	16	37.1	100
10	1 mg	1	16:30	104/65	72	16	37.1	100
Final vitals				17:00	106/67	74	16	36.5	98
Observed patients				17:45