Dementia improvement with cytotoxic chemotherapy. A case of Alzheimer disease and multiple myeloma

R. M. Keimowitz
Department of Hematology, Gundersen Lutheran Medical Center, La Crosse, Wis, USA.

OBJECTIVES: To describe a patient with Alzheimer disease and multiple myeloma (with Bence Jones proteinuria) with improvement of both conditions following cytotoxic chemotherapy, and to present issues related to the pathogenesis and management of Alzheimer disease. DESIGN: Report of a case. SETTING: Progressive dementia and myeloma developed in a 64-year-old man. Cytotoxic chemotherapy for the myeloma resulted in maintained improvement of the dementia. Clinical, neuropsychological, pathological, and laboratory data are presented. MAIN OUTCOME AND RESULTS: For 2 years, vincristine sulfate, carmustine, melphalan, cyclophosphamide, and prednisone were administered cyclically, and the patient's dementia and lambda light chain production improved. Severe dementia recurred before death and cessation of therapy, although light chain production remained decreased. CONCLUSION: Dementia improvement with cytotoxic (ie, immunosuppressive, anti-inflammatory) therapy may offer insight into the pathogenesis and management of Alzheimer disease.