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April 1976

Reversal of Systemic Manifestations of Cryoglobulinemia: Treatment With Melphalan and Prednisone

Author Affiliations

From the Department of Medicine, University of Rochester School of Medicine and Dentistry, New York. Dr Ristow is a Public Health Service Trainee in Allergy-Immunology.

Arch Intern Med. 1976;136(4):467-470. doi:10.1001/archinte.1976.03630040069014

Successful control of cutaneous manifestations of cryoparaproteinemia with melphalan (L-phenylalanine mustard) and prednisone has been reported recently.1 The present patient summary confirms the efficacy of this mode of therapy. In addition to the reversal of cutaneous lesions, systemic symptoms were eliminated, and the regression of neurologic manifestations, which were believed previously to be irreversible, was noted. Studies of the patient's sera disclosed the presence of a mixed IgG-IgM cryoglobulin with a monoclonal IgM that was notably reduced in amount after treatment but that was without change in structure or in immunochemical characteristics.

METHODS  The "cryocrit" was determined by the method described by Grossman et al.2 Venous blood was collected in warmed tubes (Vacutainer), allowed to clot at 37 C, and separated by centrifugation in a 37-C room. The serum was incubated then at 4 C for 96 hours in a 10-ml calibrated tube. The cryocrit (milliliters of packed

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