Synthesis

There is insufficient evidence of an association with AL amyloidosis and the compounds of interest. Although AL amyloidosis and multiple myeloma are similar—they both result from a clonal proliferation of plasma cells—there is insufficient evidence to link the increased risk for multiple myeloma from exposure to the compounds of interest with a possible increased risk in AL amyloidosis.

Conclusions

Strength of Evidence from Epidemiologic Studies

On the basis of its evaluation of the epidemiologic evidence reviewed here and in previous VAO reports, the committee concludes that there is inadequate or insufficient evidence to determine an association between exposure to the compounds of interest and AL amyloidosis.

Biologic Plausibility

An association was reported between primary AL amyloidosis and TCDD exposure in a single study in mice (Toth et al., 1979). However, the TCDD exposure was relatively high (0.007–7.0 µg/kg per week for 1 year) and the amyloidosis was regarded as occurring only secondary to chronic skin lesions.

Increased Risk of Disease Among Vietnam Veterans

The lack of data on the association between exposure to the chemicals of interest and AL amyloidosis, coupled with the lack of exposure information on Vietnam veterans, precludes quantification of any possible increase in their risk.

ENDOMETRIOSIS

Endometriosis (ICD-9 code 617) is a disease that affects 5.5 million women in the United States and Canada (NICHD, 2004). The endometrium is the tissue that lines the inside of the uterus that is built up and shed each month during menstruation. In endometriosis, endometrium is found outside the uterus—usually in other parts of the reproductive system, the abdomen, or the tissues near the reproductive organs. That misplaced tissue develops into growths or lesions that continue to respond to hormonal changes in the body and break down and bleed each month in concert with a woman’s menstrual cycle. Unlike blood released from endometrium in the uterus, blood released from the tissue in endometriosis has no way to leave the body, and the result is inflammation, internal bleeding,



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