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Case Report Open Access

Cardiac light chain amyloidosis secondary to Waldenström's macroglobulinemia: A case report and review

  • Authors:
    • Fang Du
    • Ai Guilan
    • Lingyun Zhou
    • Danbo Liu
    • Jiao Chen
    • Hongxian Xiang
    • Wenyi Lu
    • Jiewen Liu
    • Yanping Luo
    • Haifei Chen
  • View Affiliations / Copyright

    Affiliations: Department of Hematology, Luohu People's Hospital of Shenzhen, Shenzhen, Guangdong 518005, P.R. China, Department of Pathology, Luohu People's Hospital of Shenzhen, Shenzhen, Guangdong 518005, P.R. China, Department of Clinical Laboratory, Luohu People's Hospital of Shenzhen, Shenzhen, Guangdong 518005, P.R. China
    Copyright: © Du et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 198
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    Published online on: August 13, 2025
       https://doi.org/10.3892/etm.2025.12948
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Abstract

Cardiac light chain amyloidosis (AL) secondary to Waldenström's macroglobulinemia (WM) presents a complex challenge in medical practice due to its rarity and diagnostic difficulty. A 67‑year‑old male presented with symptoms of heart failure and was diagnosed with cardiac AL amyloidosis secondary to WM. The diagnosis of WM was confirmed through a combination of immunoglobulin (Ig) profile with abnormal IgM levels, bone marrow morphology, immunofixation electrophoresis, serum protein electrophoresis and gene mutation analysis. Cardiac amyloidosis was identified through cardiac echocardiography and confirmed through positive Congo red staining of bone marrow and apple green color transformation of an abdominal fat biopsy. The amyloid protein mass spectrometry indicated that the type of cardiac involvement was AL amyloidosis. The patient responded positively to the BR and BRD chemotherapy regimens but only showed a partial response (PR). In conclusion, a patient with WM‑AL amyloidosis was diagnosed based on the presence of abnormal IgM paraprotein levels and the high Igλ C2 peak in the amyloid protein mass spectrometry. The BR (0.15 g bendamustine on days 2‑3, 0.6 g rituximab on day 1) and BRD (2 mg bortezomib once a week for 4 weeks, 0.5 g rituximab on day 1 and 10 mg dexamethasone once a week for 4 weeks) chemotherapy regimens only achieved a partial response due to the existing irreversible organ impairment of the heart with chronic heart failure. The diagnosis of WM combined with cardiac AL amyloidosis is a challenge, and thus, it is necessary to improve clinical vigilance and early detection. Therapeutic strategies tailored to the individual patient's clinical profile are essential for optimizing outcomes, given the limited consolidated treatment evidence available for this rare condition.
View Figures

Figure 1

Echocardiography images. (A) LV (left
ventricular) posterior wall hypertrophy and thickened bilateral
atrial. (B) Various cardiac parameters with ultrasonography
measurements. (C) Low LV ejection fraction value with decreasing
blood-pumping function. (D) Decrease of LV systolic function.
Cardiac echocardiography demonstrating LV hypertrophy (16 mm),
sparkling granular echoes (amyloid deposition) and pericardial
effusion. LV, left ventricle; IVSd, interventricular septum
thickness in diastole; LVIDd, left ventricular internal diameter in
diastole; LVPWd, left ventricular posterior wall thickness in
diastole; IVSs, interventricular septum thickness in systole;
LVIDs, left ventricular internal diameter in systole; LVPWs, left
ventricular posterior wall thickness in systole; EDV, end-diastolic
volume; MM-Teich, M-mode Teichholz formula; IVS, interventricular
septum thickness; LVPW, left ventricular posterior wall thickness;
FS, fractional shortening; ESV, end-systolic volume; EF, ejection
fraction; LV, left ventricular; A4C, apical four-chamber view;
A4Cd/A4Cs, apical four-chamber view in diastole/systole; Vol,
volume; TIS, thermal index for soft tissue; MI, mechanical index;
Dist, distance.

Figure 2

Bone marrow cell morphology with
Wright Giemsa staining. The morphology of the bone marrow shows
that certain lymphocytes exhibit plasma-like differentiation, while
others show focal aggregation of lymphocytes and plasma-like
lymphocytes (magnification, x1,000) Certain lymphocytes exhibited
plasma-like differentiation and focal aggregation (red arrow). The
abnormal lymphocytes (purple colour) have plasma cell-like changes
or irregular cytoplasm edges with burrs (blue arrow).

Figure 3

Bone marrow and adipose tissue biopsy
with Congo red staining for verifying amyloidosis. (A) Bone marrow
biopsy analysis with immunohistochemistry and Congo red staining.
Congo red stain positive (scale bar, 50 µm). (B) Biopsy of
abdominal wall fat tissue with Congo red staining; amyloid proteins
display in orange red and form apple green birefringence under a
polarized fiber microscope (magnification, x400).

Figure 4

Amyloid protein mass spectrometry-Ig
light chain type (AL type). Mass spectrometry peaks identify Igλ C2
and µ heavy chain as the dominant amyloid protein. Ig,
immunoglobulin; Fibα, fibrinogen α chain; Gel, gelsolin.
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Copy and paste a formatted citation
Spandidos Publications style
Du F, Guilan A, Zhou L, Liu D, Chen J, Xiang H, Lu W, Liu J, Luo Y, Chen H, Chen H, et al: Cardiac light chain amyloidosis secondary to Waldenström's macroglobulinemia: A case report and review. Exp Ther Med 30: 198, 2025.
APA
Du, F., Guilan, A., Zhou, L., Liu, D., Chen, J., Xiang, H. ... Chen, H. (2025). Cardiac light chain amyloidosis secondary to Waldenström's macroglobulinemia: A case report and review. Experimental and Therapeutic Medicine, 30, 198. https://doi.org/10.3892/etm.2025.12948
MLA
Du, F., Guilan, A., Zhou, L., Liu, D., Chen, J., Xiang, H., Lu, W., Liu, J., Luo, Y., Chen, H."Cardiac light chain amyloidosis secondary to Waldenström's macroglobulinemia: A case report and review". Experimental and Therapeutic Medicine 30.4 (2025): 198.
Chicago
Du, F., Guilan, A., Zhou, L., Liu, D., Chen, J., Xiang, H., Lu, W., Liu, J., Luo, Y., Chen, H."Cardiac light chain amyloidosis secondary to Waldenström's macroglobulinemia: A case report and review". Experimental and Therapeutic Medicine 30, no. 4 (2025): 198. https://doi.org/10.3892/etm.2025.12948
Copy and paste a formatted citation
x
Spandidos Publications style
Du F, Guilan A, Zhou L, Liu D, Chen J, Xiang H, Lu W, Liu J, Luo Y, Chen H, Chen H, et al: Cardiac light chain amyloidosis secondary to Waldenström's macroglobulinemia: A case report and review. Exp Ther Med 30: 198, 2025.
APA
Du, F., Guilan, A., Zhou, L., Liu, D., Chen, J., Xiang, H. ... Chen, H. (2025). Cardiac light chain amyloidosis secondary to Waldenström's macroglobulinemia: A case report and review. Experimental and Therapeutic Medicine, 30, 198. https://doi.org/10.3892/etm.2025.12948
MLA
Du, F., Guilan, A., Zhou, L., Liu, D., Chen, J., Xiang, H., Lu, W., Liu, J., Luo, Y., Chen, H."Cardiac light chain amyloidosis secondary to Waldenström's macroglobulinemia: A case report and review". Experimental and Therapeutic Medicine 30.4 (2025): 198.
Chicago
Du, F., Guilan, A., Zhou, L., Liu, D., Chen, J., Xiang, H., Lu, W., Liu, J., Luo, Y., Chen, H."Cardiac light chain amyloidosis secondary to Waldenström's macroglobulinemia: A case report and review". Experimental and Therapeutic Medicine 30, no. 4 (2025): 198. https://doi.org/10.3892/etm.2025.12948
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