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Reversal of Systemic Manifestations of Cryoglobulinemia: Treatment With Melphalan and Prednisone

Reversal of Systemic Manifestations of Cryoglobulinemia: Treatment With Melphalan and Prednisone Abstract Successful control of cutaneous manifestations of cryoparaproteinemia with melphalan (L-phenylalanine mustard) and prednisone has been reported recently.1 The present patient summary confirms the efficacy of this mode of therapy. In addition to the reversal of cutaneous lesions, systemic symptoms were eliminated, and the regression of neurologic manifestations, which were believed previously to be irreversible, was noted. Studies of the patient's sera disclosed the presence of a mixed IgG-IgM cryoglobulin with a monoclonal IgM that was notably reduced in amount after treatment but that was without change in structure or in immunochemical characteristics. METHODS The "cryocrit" was determined by the method described by Grossman et al.2 Venous blood was collected in warmed tubes (Vacutainer), allowed to clot at 37 C, and separated by centrifugation in a 37-C room. The serum was incubated then at 4 C for 96 hours in a 10-ml calibrated tube. The cryocrit (milliliters of packed References 1. Brody JI, Samitz MH: Cutaneous signs of cryoparaproteinemia: Control with burst Alkeran and prednisone . Am J Med 55:211-214, 1973.Crossref 2. Grossman J, Abraham GN, Leddy JP, et al: Crystalglobulinemia . Ann Intern Med 77:395-400, 1972.Crossref 3. Trieshmann HW, Abraham GN, Santucci EA: The characterization of human anti-IgG autoantibodies by liquid isoelectric focussing . J Im munol 114:176-181, 1975. 4. Abraham GN, Clark RA, Vaughan JH: Characterization of an IgA rheumatoid factor: Binding properties and reactivity with the subclasses of human γ-globulin . Immunochemistry 9:301-315, 1972.Crossref 5. Steinhardt MJ, Fischer GS: Cold urticaria and purpura as allergic aspects of cryoglobulinemia . J Allergy 24:335-341, 1953.Crossref 6. Pelzig A: Essential cryoglobulinemia with purpura . Arch Derm Syph 67:429-430, 1953. 7. Hutchinson JH, Howell RA: Cryoglobulinemia: Report of a case associated with gangrene of the digits . Ann Intern Med 29:350-357, 1953. 8. Volpe R, Bruce-Robertson A, Fletcher AA, et al: Essential cryoglobulinemia: Review of the literature and report of a case treated with ACTH and cortisone . Am J Med 20:533-553, 1956.Crossref 9. Meltzer M, Franklin EC, Elias K, et al: Cryoglobulinemia: A clinical and laboratory study: II. Cryoglobulins with rheumatoid factor activity . Am J Med 40:837-856, 1966.Crossref 10. Meltzer M, Franklin EC: Cryoglobulins, rheumatoid factors, and connective tissue disorders . Arthritis Rheum 10:489-492, 1967.Crossref 11. Lapes MJ, Davis JS: Arthralgia—purpura— weakness—cryoglobulinemia . Arch Intern Med 126:287-289, 1970.Crossref 12. Logothetis J, Kennedy WR, Ellington A, et al: Cryoglobulinemic neuropathy: Incidence and clinical characteristics . Arch Neurol 19:389-397, 1968.Crossref 13. Cream JJ, Hern JEC, Hughes RAC, et al: Mixed or immune complex cryoglobulinaemia and neuropathy . J Neurol Neurosurg Psychiatry 37:82-87, 1974.Crossref 14. Abramsky O, Slavin S: Neurologic manifestations in patients with mixed cryoglobulinemia . Neurology 24:245-249, 1974.Crossref 15. Grey HM, Kohler PF: Cryoimmunoglobulins . Sem Hematol 10:87-112, 1973. 16. Goldberg LS, Barnett EV: Essential cryoglobulinemia: Immunologic studies before and after penicillamine therapy . Arch Intern Med 125:145-150, 1970.Crossref 17. Costanzi JJ, Coltman CA Jr, Clark DA, et al: Cryoglobulinemia associated with a macroglobulin: Studies of a 17.5 S cryoprecipitating factor . Am J Med 39:163-172, 1965.Crossref 18. Golde D, Epstein W: Mixed cryoglobulins and glomerulonephritis . Ann Intern Med 69:1221-1227, 1968.Crossref 19. Mathison DA, Condemi JJ, Leddy JP, et al: Purpura, arthralgia, and IgM-IgG cryoglobulinemia with rheumatoid factor activity: Response to cyclophosphamide and splenectomy . Ann Intern Med 74:383-390, 1971.Crossref 20. Farhangi M, Osserman EF: The treatment of multiple myeloma . Sem Hematol 10:149-161, 1973. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Reversal of Systemic Manifestations of Cryoglobulinemia: Treatment With Melphalan and Prednisone

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Publisher
American Medical Association
Copyright
Copyright © 1976 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1976.03630040069014
Publisher site
See Article on Publisher Site

Abstract

Abstract Successful control of cutaneous manifestations of cryoparaproteinemia with melphalan (L-phenylalanine mustard) and prednisone has been reported recently.1 The present patient summary confirms the efficacy of this mode of therapy. In addition to the reversal of cutaneous lesions, systemic symptoms were eliminated, and the regression of neurologic manifestations, which were believed previously to be irreversible, was noted. Studies of the patient's sera disclosed the presence of a mixed IgG-IgM cryoglobulin with a monoclonal IgM that was notably reduced in amount after treatment but that was without change in structure or in immunochemical characteristics. METHODS The "cryocrit" was determined by the method described by Grossman et al.2 Venous blood was collected in warmed tubes (Vacutainer), allowed to clot at 37 C, and separated by centrifugation in a 37-C room. The serum was incubated then at 4 C for 96 hours in a 10-ml calibrated tube. The cryocrit (milliliters of packed References 1. Brody JI, Samitz MH: Cutaneous signs of cryoparaproteinemia: Control with burst Alkeran and prednisone . Am J Med 55:211-214, 1973.Crossref 2. Grossman J, Abraham GN, Leddy JP, et al: Crystalglobulinemia . Ann Intern Med 77:395-400, 1972.Crossref 3. Trieshmann HW, Abraham GN, Santucci EA: The characterization of human anti-IgG autoantibodies by liquid isoelectric focussing . J Im munol 114:176-181, 1975. 4. Abraham GN, Clark RA, Vaughan JH: Characterization of an IgA rheumatoid factor: Binding properties and reactivity with the subclasses of human γ-globulin . Immunochemistry 9:301-315, 1972.Crossref 5. Steinhardt MJ, Fischer GS: Cold urticaria and purpura as allergic aspects of cryoglobulinemia . J Allergy 24:335-341, 1953.Crossref 6. Pelzig A: Essential cryoglobulinemia with purpura . Arch Derm Syph 67:429-430, 1953. 7. Hutchinson JH, Howell RA: Cryoglobulinemia: Report of a case associated with gangrene of the digits . Ann Intern Med 29:350-357, 1953. 8. Volpe R, Bruce-Robertson A, Fletcher AA, et al: Essential cryoglobulinemia: Review of the literature and report of a case treated with ACTH and cortisone . Am J Med 20:533-553, 1956.Crossref 9. Meltzer M, Franklin EC, Elias K, et al: Cryoglobulinemia: A clinical and laboratory study: II. Cryoglobulins with rheumatoid factor activity . Am J Med 40:837-856, 1966.Crossref 10. Meltzer M, Franklin EC: Cryoglobulins, rheumatoid factors, and connective tissue disorders . Arthritis Rheum 10:489-492, 1967.Crossref 11. Lapes MJ, Davis JS: Arthralgia—purpura— weakness—cryoglobulinemia . Arch Intern Med 126:287-289, 1970.Crossref 12. Logothetis J, Kennedy WR, Ellington A, et al: Cryoglobulinemic neuropathy: Incidence and clinical characteristics . Arch Neurol 19:389-397, 1968.Crossref 13. Cream JJ, Hern JEC, Hughes RAC, et al: Mixed or immune complex cryoglobulinaemia and neuropathy . J Neurol Neurosurg Psychiatry 37:82-87, 1974.Crossref 14. Abramsky O, Slavin S: Neurologic manifestations in patients with mixed cryoglobulinemia . Neurology 24:245-249, 1974.Crossref 15. Grey HM, Kohler PF: Cryoimmunoglobulins . Sem Hematol 10:87-112, 1973. 16. Goldberg LS, Barnett EV: Essential cryoglobulinemia: Immunologic studies before and after penicillamine therapy . Arch Intern Med 125:145-150, 1970.Crossref 17. Costanzi JJ, Coltman CA Jr, Clark DA, et al: Cryoglobulinemia associated with a macroglobulin: Studies of a 17.5 S cryoprecipitating factor . Am J Med 39:163-172, 1965.Crossref 18. Golde D, Epstein W: Mixed cryoglobulins and glomerulonephritis . Ann Intern Med 69:1221-1227, 1968.Crossref 19. Mathison DA, Condemi JJ, Leddy JP, et al: Purpura, arthralgia, and IgM-IgG cryoglobulinemia with rheumatoid factor activity: Response to cyclophosphamide and splenectomy . Ann Intern Med 74:383-390, 1971.Crossref 20. Farhangi M, Osserman EF: The treatment of multiple myeloma . Sem Hematol 10:149-161, 1973.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Apr 1, 1976

References