Epigallocathechin-3-gallate in AL amyloidosis: a new therapeutic option?

To the editor:

This unusual letter comes from Heidelberg, where the first description of amyloidosis was published in 1859.¹  The first autologous transplantation of blood-derived hematopoietic stem cells was conducted here in 1985 in my university hospital department and reported in Blood in 1986.² 

At the present time, I am—as an emeritus professor of internal medicine and hematology—a patient, suffering from lambda light-chain amyloidosis since 2001, when I was 72, although it was not diagnosed until 2004. The illness has peculiarities that make it worth reporting. A short-term therapy with the “Boston scheme” (4 mg melphalan daily for 21 days) showed no response. Therapy according to the “Palladini scheme” (0.22 mg/kg melphalan and 40 mg dexamethasone for 4 days every 28 days) stabilized the disease, but at high cost because of the side effects. After 14 cycles (a total of 872 mg melphalan and 2400 mg dexamethasone), “drug holidays” were recommended by the German, Italian, and American physicians in charge of my treatment.

These “holidays” have been extended since September 2006. The drug treatment was not resumed because of the apparent effectiveness of an entirely different approach: since September 2006, I have ingested daily 1.5 to 2.0 L of green tea, effective presumably because of its contents of EGCG (epigallocatechin gallate) and other phenols.

Recommendation of this “therapy” came from former members of my staff on the basis of a lecture by Prof E. E. Wanker alerting them to in vitro experiments reporting the effects of EGCG on light chains and amyloid fibrils (Ehrnhoefer DE, Bieschke J, Boeddrich A, et al; submitted manuscript). These results impressed me, a hematologist rooted deeply in the natural sciences, so I decided to follow the advice to drink green tea on a daily basis.

The results are incredible. For 20 months, the interventricular septum had remained constant at 16.5 mm, which we considered the successful effect of chemotherapy. Since September 2006, it has decreased month by month to what is at present a constant thickness of 13.2 mm. The longitudinal myocardial deformation showed a clear improvement. The light chains do not exceed 50 mg/L; the kappa/lambda ratio remains steady between 0.74 and 0.50. The renal insufficiency remains unchanged with values of creatinine at 229.84 μmol/L (2.6 mg/dL) and urea at 24.99 μmol/L (70 mg/dL). And, most surprisingly, my quality of life has improved dramatically despite my now 78 years of age.

Since I am experiencing the objective and subjective improvements of my health, I am encouraged to present my case for your consideration. Because of the rarity of the disease, international clinical studies in amyloidosis should take note of this singular case, as with patients with lymphoma³  after taking notice of “furtive green tea drinkers” among them. EGCG, a commercially available white powder, should be made a therapeutic option soon.