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RCD chemotherapy in Waldenström macroglobulinemia with AL amyloidosis led to rapid progression and deathRare Blood Cancer Causes Fast Kidney Failure

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Key Takeaway
Note that RCD chemotherapy in this rare case resulted in rapid progression and death from multiple organ failure.

A case report and literature review examined the clinical course of a single 75-year-old female patient diagnosed with Waldenström macroglobulinemia and AL lambda-type amyloid nephropathy. The patient received chemotherapy consisting of rituximab, cyclophosphamide, and dexamethasone (the RCD regimen), alongside symptomatic supportive therapy. This intervention occurred within a clinical practice setting rather than a controlled trial environment.

Following treatment initiation, the patient demonstrated temporary improvement in clinical symptoms and laboratory parameters. However, this initial response was not sustained. The patient subsequently experienced rapid disease progression. Follow-up data were collected approximately three months after discharge.

The primary outcome of disease progression was unfavorable, culminating in the patient's death. The cause of death was attributed to multiple organ failure involving cardiac, renal, and respiratory dysfunction. No specific adverse events or tolerability data were reported beyond this fatal outcome. The study did not report statistical significance or confidence intervals, as is typical for single-patient case reports. Limitations inherent to this study design include the small sample size of one patient and the lack of a control group, which restricts the ability to draw broad causal conclusions. The findings may offer clinical guidance for similar rare cases but require cautious interpretation due to the lack of generalizability.

The Hidden Danger

Imagine waking up with a swollen face and heavy, puffy legs. For most people, this feels like a bad allergy or just holding too much salt. But for a 75-year-old woman, these were the first signs of something much more serious. She also noticed her urine looked foamy and she had to run to the bathroom constantly. These simple changes signaled that her kidneys were struggling to work.

Doctors found a rare type of blood cancer called Waldenström macroglobulinemia. This disease involves a specific kind of white blood cell that starts making too much protein. Usually, this stays in the blood. But in this case, the protein stuck inside the kidneys. It built up like a clog in a drain, stopping the organ from filtering waste.

Kidney failure is scary enough on its own. But when it happens because of this specific blood cancer, it moves very fast. The woman's kidney function dropped quickly after she was diagnosed. Her body could no longer clean the blood, leading to a buildup of toxins. This situation is rare, which makes it hard for doctors to find the right answer quickly. Most patients do not expect their cancer to attack their kidneys so aggressively.

For years, doctors treated this blood cancer with a mix of medicines called RCD. This stands for Rituximab, Cyclophosphamide, and Dexamethasone. These drugs are powerful. They help the immune system fight the cancer cells. In this case, the treatment did work at first. The swelling went down, and the urine looked better.

But here is the twist. The relief was only temporary. The cancer cells kept growing, and the protein continued to clog the kidneys. The treatment could not keep up with how fast the disease was spreading. This shows that even strong medicines might not be enough for every patient.

Think of your kidneys as a coffee filter. They let clean water pass through while trapping dirt and waste. In this patient's body, the cancer made a sticky, glue-like protein. This protein acted like a thick layer of coffee grounds. It stuck to the filter and blocked the holes.

Normally, the body tries to clean itself. But this specific protein is very stubborn. It forms tiny fibers called amyloid. These fibers pile up in the kidney's tiny filtering units. Once they are there, they damage the structure permanently. It is like trying to unclog a drain with wet cement. The more protein that builds up, the harder it is for the kidneys to work.

Doctors looked at this specific patient and reviewed similar cases in medical records. The patient was a 75-year-old woman. She had a genetic marker called MYD88-L265P, which is common in this type of cancer. Her kidney biopsy showed the specific type of protein buildup. The team watched her closely for three months after she left the hospital.

The most important finding is how fast things can change. Even though the initial treatment helped, the patient's condition worsened quickly. Within three months, her heart, kidneys, and lungs all started failing at the same time. This is called multiple organ failure. It is a very serious situation where the body can no longer support life.

The tests showed huge amounts of protein in her urine. Her blood protein levels were dangerously low. These numbers tell a story of a body under extreme stress. The cancer was not just sitting in the blood; it was actively destroying vital organs.

But there is a catch. This story is not just about one person. It shows a pattern that doctors need to watch for. When this specific type of protein builds up in the kidneys, the outlook is often poor. The standard treatments that work for many cancer patients do not always work here.

Medical experts agree that this combination of cancer and kidney disease is complex. The 2022 Chinese Expert Consensus provides guidelines for these rare cases. It suggests that doctors must look closely at the type of protein involved. Sometimes, the treatment needs to change if the kidneys are getting worse. Waiting for standard results might not be an option when organs are failing.

If you or a loved one has this rare blood cancer, pay attention to new symptoms. Swelling in the face or legs, foamy urine, and needing to pee often are warning signs. Do not ignore them. Talk to your doctor immediately if you notice these changes. Early detection is key to slowing down the damage.

This report is based on one patient and a review of other similar cases. It is not a large study with thousands of people. Because the situation is so rare, there is not much data to predict exactly what will happen to every patient. Every person's body reacts differently to cancer and treatment.

Researchers are looking for better ways to stop the protein from building up in the kidneys. New drugs and therapies are being tested to see if they can clear the clog faster. Until then, doctors must be ready to act quickly when they see these warning signs. The goal is to protect the kidneys and keep the patient stable for as long as possible.

Study Details

Study typeGuideline
EvidenceLevel 5
PublishedApr 2026
View Original Abstract ↓
Waldenström macroglobulinemia (WM) is a rare CD20-positive B-cell non-Hodgkin lymphoma. It is characterized by lymphoplasmacytic infiltration in the bone marrow and abnormal monoclonal IgM secretion. WM complicated by renal amyloidosis is uncommon but associated with rapid progression of organ damage. Accurate identification of pathogenic factors and individualized treatments are essential to improve prognosis. This paper reports the case of a 75-year-old female who initially presented with facial edema and bilateral lower-extremity edema lasting 2 days. Additional symptoms included foamy urine, frequent urination, and urgency. Laboratory tests revealed significant proteinuria (24-h urinary protein, 6.11 g), hypoalbuminemia (serum albumin, 20.07 g/L), and impaired renal function (serum creatinine, 129.90 μmol/L; eGFR, 45.2 mL/min/1.73 m2). Immunofixation electrophoresis detected monoclonal IgM-λ immunoglobulin in both serum and urine. Bone marrow biopsy demonstrated clonal lymphoplasmacytic infiltration (32%), and genetic testing revealed a positive MYD88-L265P mutation (mutation frequency, 28.5%). Renal biopsy indicated diffuse deposition of λ light chains predominantly in the glomerular mesangium. Ultrastructural examination revealed amyloid fibrils, confirming the diagnosis of AL λ − type amyloid nephropathy. Chemotherapy with rituximab, cyclophosphamide, and dexamethasone (RCD regimen), combined with symptomatic supportive therapy, resulted in temporary improvement of clinical symptoms and laboratory parameters. However, the disease progressed rapidly. The patient died on Jan 28, 2024, approximately 3 months after discharge, due to multiple organ failure involving cardiac, renal, and respiratory dysfunction. Based on relevant literature and the Chinese Expert Consensus on Diagnosis and Treatment of Lymphoplasmacytic Lymphoma (LPL)/WM (2022 Edition) [Abstract 3], this paper discusses diagnostic criteria, differentiation of pathogenic components, treatment strategies, and prognostic factors. These findings may provide clinical guidance for similar rare cases.
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