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Dementia Improvement With Cytotoxic Chemotherapy: A Case of Alzheimer Disease and Multiple Myeloma

Dementia Improvement With Cytotoxic Chemotherapy: A Case of Alzheimer Disease and Multiple Myeloma Abstract Objectives: To describe a patient with Alzheimer disease and multiple myeloma (with Bence Jones proteinuria) with improvement of both conditions following cytotoxic chemotherapy, and to present issues related to the pathogenesis and management of Alzheimer disease. Design: Report of a case. Setting: Progressive dementia and myeloma developed in a 64-year-old man. Cytotoxic chemotherapy for the myeloma resulted in maintained improvement of the dementia. Clinical, neuropsychological, pathological, and laboratory data are presented. Main Outcome and Results: For 2 years, vincristine sulfate, carmustine, melphalan, cyclophosphamide, and prednisone were administered cyclically, and the patient's dementia and λ light chain production improved. Severe dementia recurred before death and cessation of therapy, although light chain production remained decreased. Conclusion: Dementia improvement with cytotoxic (ie, immunosuppressive, anti-inflammatory) therapy may offer insight into the pathogenesis and management of Alzheimer disease. References 1. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease . Neurology . 1984;34:939-945.Crossref 2. Inestrosa NC, Soto C. Molecular biology of the amyloid of Alzheimer's disease: an overview . Biol Res . 1992;25:63-72. 3. Polvikoski T, Sulkava R, Haltia M, et al. Apolipoprotein E, dementia, and cortical deposition of beta-amyloid protein . N Engl J Med . 1995;333:1242-1247.Crossref 4. Kyle RA. Multiple myeloma: review of 869 cases . Mayo Clin Proc . 1975;50:29-40. 5. Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases . Semin Hematol . 1995;32:45-59. 6. Kokmen E, Naessens JM, Offord KP. A short test of mental status: description and preliminary results . Mayo Clin Proc . 1987;62:281-288.Crossref 7. Case DC, Lee BJ, Clarkson BD. Improved survival times in multiple myeloma treated with melphalan, prednisone, cyclophosphamide, vincristine and BCNU: M-2 protocol . Am J Med . 1977;63:897-903.Crossref 8. Soto C, Branes C, Alvarez J, Inestrosa NC. Structural determinants of the Alzheimer's amyloid β-peptide . J Neurochem . 1994;63:1191-1198.Crossref 9. McGeer PL, McGeer E, Rogers J, Sibley J. Anti-inflammatory drugs and Alzheimer's disease . Lancet . 1992;335:1037.Crossref 10. Rogers J, Kirby LC, Hempelman SR, et al. Clinical trial of indomethacin in Alzheimer's disease . Neurology . 1993;43:1609-1611.Crossref 11. Calabresi P, Chabner BA. Antineoplastic agents . In: The Pharmacological Basis of Therapeutics . 8th ed. Elmsford, NY: Pergamon Press Inc; 1990;1209-1263. 12. Haynes RC Jr. Adrenocorticotropic hormone: adrenocortical steroids and their synthetic analogs: inhibitors of the synthesis and actions of adrenocortical hormones . In: The Pharmacological Basis of Therapeutics . 8th ed. Elmsford, NY: Pergamon Press Inc; 1990:1442-1461. 13. Thal LJ, Salivan JP, Lark B. Safety and lack of efficacy of vinpocetine in Alzheimer's disease . J Am Geriatr Soc . 1989;37:515-520. 14. Oliverio VT. Pharmacology of the nitrosoureas: an overview . Cancer Treat Rep . 1976;60:703-707. 15. Caputo CB, Salama Al. The amyloid proteins of Alzheimer's disease as potential targets for drug therapy . Neurobiol Aging . 1989;10:451-461.Crossref 16. Sisodia SS, Price DL. Role of the βamyloid protein in Alzheimer's disease . FASEB J . 1995;9:366-370. 17. Yankner BA, Dawes LR, Fisher S, et al. Neurotoxicity of a fragment of the amyloid precursor associated with Alzheimer's disease . Science . 1989;245:417-420.Crossref 18. Aisen PS, Davis KL. Inflammatory mechanisms of Alzheimer's disease: implications for therapy . Am J Psychiatry . 1994;151:8. 19. McGeer PL, Rogers J. Anti-inflammatory agents as a therapeutic approach to Alzheimer's disease . Neurology . 1992;42:447-449.Crossref 20. Altstiel L, Sperber K. Cytokines in Alzheimer's disease . Prog Neuropsychopharmacol Biol Psychiatry . 1991;15:481-495.Crossref 21. Pasinetti GM. Inflammatory mechanisms in neurodegeneration and Alzheimer's disease: the role of the complement system . Neurobiol Aging . 1996;17:707-716.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Dementia Improvement With Cytotoxic Chemotherapy: A Case of Alzheimer Disease and Multiple Myeloma

Archives of Neurology , Volume 54 (4) – Apr 1, 1997

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References (23)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1997.00550160111024
Publisher site
See Article on Publisher Site

Abstract

Abstract Objectives: To describe a patient with Alzheimer disease and multiple myeloma (with Bence Jones proteinuria) with improvement of both conditions following cytotoxic chemotherapy, and to present issues related to the pathogenesis and management of Alzheimer disease. Design: Report of a case. Setting: Progressive dementia and myeloma developed in a 64-year-old man. Cytotoxic chemotherapy for the myeloma resulted in maintained improvement of the dementia. Clinical, neuropsychological, pathological, and laboratory data are presented. Main Outcome and Results: For 2 years, vincristine sulfate, carmustine, melphalan, cyclophosphamide, and prednisone were administered cyclically, and the patient's dementia and λ light chain production improved. Severe dementia recurred before death and cessation of therapy, although light chain production remained decreased. Conclusion: Dementia improvement with cytotoxic (ie, immunosuppressive, anti-inflammatory) therapy may offer insight into the pathogenesis and management of Alzheimer disease. References 1. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease . Neurology . 1984;34:939-945.Crossref 2. Inestrosa NC, Soto C. Molecular biology of the amyloid of Alzheimer's disease: an overview . Biol Res . 1992;25:63-72. 3. Polvikoski T, Sulkava R, Haltia M, et al. Apolipoprotein E, dementia, and cortical deposition of beta-amyloid protein . N Engl J Med . 1995;333:1242-1247.Crossref 4. Kyle RA. Multiple myeloma: review of 869 cases . Mayo Clin Proc . 1975;50:29-40. 5. Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases . Semin Hematol . 1995;32:45-59. 6. Kokmen E, Naessens JM, Offord KP. A short test of mental status: description and preliminary results . Mayo Clin Proc . 1987;62:281-288.Crossref 7. Case DC, Lee BJ, Clarkson BD. Improved survival times in multiple myeloma treated with melphalan, prednisone, cyclophosphamide, vincristine and BCNU: M-2 protocol . Am J Med . 1977;63:897-903.Crossref 8. Soto C, Branes C, Alvarez J, Inestrosa NC. Structural determinants of the Alzheimer's amyloid β-peptide . J Neurochem . 1994;63:1191-1198.Crossref 9. McGeer PL, McGeer E, Rogers J, Sibley J. Anti-inflammatory drugs and Alzheimer's disease . Lancet . 1992;335:1037.Crossref 10. Rogers J, Kirby LC, Hempelman SR, et al. Clinical trial of indomethacin in Alzheimer's disease . Neurology . 1993;43:1609-1611.Crossref 11. Calabresi P, Chabner BA. Antineoplastic agents . In: The Pharmacological Basis of Therapeutics . 8th ed. Elmsford, NY: Pergamon Press Inc; 1990;1209-1263. 12. Haynes RC Jr. Adrenocorticotropic hormone: adrenocortical steroids and their synthetic analogs: inhibitors of the synthesis and actions of adrenocortical hormones . In: The Pharmacological Basis of Therapeutics . 8th ed. Elmsford, NY: Pergamon Press Inc; 1990:1442-1461. 13. Thal LJ, Salivan JP, Lark B. Safety and lack of efficacy of vinpocetine in Alzheimer's disease . J Am Geriatr Soc . 1989;37:515-520. 14. Oliverio VT. Pharmacology of the nitrosoureas: an overview . Cancer Treat Rep . 1976;60:703-707. 15. Caputo CB, Salama Al. The amyloid proteins of Alzheimer's disease as potential targets for drug therapy . Neurobiol Aging . 1989;10:451-461.Crossref 16. Sisodia SS, Price DL. Role of the βamyloid protein in Alzheimer's disease . FASEB J . 1995;9:366-370. 17. Yankner BA, Dawes LR, Fisher S, et al. Neurotoxicity of a fragment of the amyloid precursor associated with Alzheimer's disease . Science . 1989;245:417-420.Crossref 18. Aisen PS, Davis KL. Inflammatory mechanisms of Alzheimer's disease: implications for therapy . Am J Psychiatry . 1994;151:8. 19. McGeer PL, Rogers J. Anti-inflammatory agents as a therapeutic approach to Alzheimer's disease . Neurology . 1992;42:447-449.Crossref 20. Altstiel L, Sperber K. Cytokines in Alzheimer's disease . Prog Neuropsychopharmacol Biol Psychiatry . 1991;15:481-495.Crossref 21. Pasinetti GM. Inflammatory mechanisms in neurodegeneration and Alzheimer's disease: the role of the complement system . Neurobiol Aging . 1996;17:707-716.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Apr 1, 1997

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