Acquired Factor X Deficiency and Amyloidosis Treated with Melphalan and Prednisone

To the Editor: In the article “Resolution of Acquired Factor X Deficiency and Amyloidosis with Melphalan and Prednisone Therapy“” (April 30 issue),¹ Camoriano et al. failed to address the prompt reversal of bleeding symptoms associated with melphalan and prednisone. Changes in amyloid deposits have been reported to occur over prolonged periods.² In fact, the factor X level in the patient¹ was still only 1 percent on December 3, 1985, when no symptoms of bleeding were observed. The authors neglected to discuss the prolonged thrombin time and reptilase time, which may represent a dysfibrinogenemia associated with the documented liver disease.³ Furthermore,.