UNASSIGNED: The detection and quantification of amyloidogenic monoclonal light chains are necessary for the diagnosis and evaluation of response to treatment in @entity1582 . However, the amyloid clone is often small and difficult to detect. We report the case of a 68-year-old @entity1 who was referred to our Center in April 2013 after @entity1163 and the identification of @entity4346 at echocardiography, suspected for @entity2783 . A commercial agarose gel electrophoresis immunofixation (IFE) did not reveal monoclonal components in serum and urine. The k serum @entity3917 ( @entity3917 ) concentration was 21.5 mg/L,    33 mg/L (k/   ratio 0.65), NT-proBNP 9074 ng/L (u.r.l. <332 ng/L) and an echocardiogram confirmed characteristic features of @entity2783 . The abdominal fat aspiration was positive and the amyloid typing by immune-electron microscopy revealed    light chains deposits. A high-resolution (hr) IFE of serum and urine showed a faint monoclonal    component in the urine. A bone marrow biopsy showed 8% plasma cells (BMPC) and a kappa/lambda light-chain restriction with    light chain on immunofluorescence. The diagnosis of @entity1582 (  ) @entity2783 with cardiac involvement was made. In May 2013, @entity1 was started on @entity786 , @entity1749 and @entity619 . After six cycles, serum and urine hr-IFE were negative, the bone marrow biopsy showed 3% BMPC without light chain restriction by immunofluorescence, and a decrease of NT-proBNP was observed (5802 ng/L).Thus, treatment was discontinued. In this @entity1 the amyloid clone could be detected only by in house hr-IFE of urine and bone marrow examination. The detection of the small dangerous amyloidogenic clone should be pursued with a combination of high-sensitivity techniques, including assessment of BMPC clonality. Studies of novel tools, such as mass spectrometry on serum and next-generation flow cytometry analysis of the bone marrow, for detecting plasma cell clones in @entity1582 and other monoclonal light chain-related disorders are warranted.

A XXXX with @entity1582 with negative @entity3917 results.

@entity1 :: ('9606', 'Species') :: ['patient', 'man'] @entity2783 :: ('MESH:D000686', 'Disease') :: ['amyloidosis'] @entity786 :: ('MESH:D003520', 'Chemical') :: ['cyclophosphamide'] @entity1163 :: ('MESH:D013575', 'Disease') :: ['syncope'] @entity1582 :: ('MESH:D009101', 'Disease') :: ['AL amyloidosis', 'AL'] @entity619 :: ('MESH:D003907', 'Chemical') :: ['dexamethasone'] @entity4346 :: ('MESH:D017379', 'Disease') :: ['left ventricular hypertrophy'] @entity1749 :: ('MESH:C400082', 'Chemical') :: ['bortezomib'] @entity3917 :: ('MESH:D020795', 'Disease') :: ['free light chain', 'FLC']
@entity1 :: (9606,Species) :: ['patient']
