Resolution of Acquired Factor X Deficiency and Amyloidosis with Melphalan and Prednisone Therapy

ALTHOUGH primary amyloidosis is refractory to most treatments, there have been some reports of limited but definite clinical improvements in patients treated with melphalan and prednisone.^{1 2 3 4 5 6} The improvements have included resolution of the nephrotic syndrome,⁷ a decrease in the size of the spleen and liver, normalization of the levels of hepatic enzymes,⁶ a decline in light-chain synthesis,³ and a reduction of amyloid in sequential liver-biopsy specimens.⁶ Since the first report (in 1962) of acquired factor X deficiency in amyloidosis,⁸ more than 30 cases have been described.^{9 10 11 12 13 14 15 16} Patients with this disorder may have life-threatening bleeding that is usually difficult to manage…