4.6 Article

A UK consensus algorithm for early treatment modification in newly diagnosed systemic light-chain amyloidosis

Journal

BRITISH JOURNAL OF HAEMATOLOGY
Volume 198, Issue 2, Pages 328-332

Publisher

WILEY
DOI: 10.1111/bjh.18216

Keywords

amyloidosis; multiple myeloma; MGUS

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This study found that depth of response is critical in the prognosis of AL amyloidosis. By analyzing patients' baseline characteristics and 1-month response, those unlikely to improve treatment response can be identified. It is recommended that patients with a significant difference in involved and uninvolved serum free light chains at diagnosis and no response at 1 month switch treatment early.
Depth of response is the critical determinant of prognosis in amyloid light-chain (AL) amyloidosis. Here, we aim to identify patients who are unlikely to improve response based on analysis of baseline characteristics and 1-month response. In a multivariate model, difference in involved amyloidogenic and uninvolved serum free light chains (dFLC) at diagnosis (dFLC >400 mg/l, odds ratio [OR] 4.051, p < 0.005) and no response at 1 month (OR 4.787, p < 0.005) were significant predictors of no improvement in response. Only 5% of patients with a dFLC of >400 mg/l and no response at 1 month improved their response (p < 0.005). We suggest that these patients should switch treatment early, subject to their functional status.

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