64 year old woman with AL amyloidosis with pulmonary (lung biopsy 2017), GI (duodenal biopsy 2015) and presumed lymph node involvement an underlying lambda clonal plasma cell dyscrasia. She underwent 8 cycles of CyBorD then 2 cycles of RVD after which treatment was stopped.
Today, she has no symptoms or signs of progressive disease. Pulmonary evaluation is pending (PFTs, Chest CT to be ordered). She maintains a good hematologic response to therapy – SPEP does not show a monoclonal protein and there is no elevation of lambda light chains corresponding to her underlying disease at diagnosis. Prior bone marrow biopsy showed normocellular marrow, moderate lambda skewing of the light chain ratio but no amyloid deposition by congo red staining.
Innumerable calcified pulmonary nodules and partially calcified
supraclavicular, mediastinal, and hilar lymph nodes, likely related to the patient’s history of amyloidosis.