title: What is new in diagnosis and management of light chain amyloidosis?
abstract: Light chain (AL) amyloidosis is caused by a usually small plasma cell clone producing a misfolded light chain that deposits in tissues. Survival is mostly determined by the severity of heart involvement. Recent studies are clarifying the mechanisms of cardiac damage, pointing to a toxic effect of amyloidogenic light chains and offering new potential therapeutic targets. The diagnosis requires adequate technology, available at referral centers, for amyloid typing. Late diagnosis results in approximately 30% of patients presenting with advanced, irreversible organ involvement and dying in a few months despite modern treatments. The availability of accurate biomarkers of clonal and organ disease is reshaping the approach to patients with AL amyloidosis. Screening of early organ damage based on biomarkers can help identify patients with monoclonal gammopathy of undetermined significance who are developing AL amyloidosis before they become symptomatic. Staging systems and response assessment based on biomarkers facilitate the design and conduction of clinical trials, guide the therapeutic strategy, and allow the timely identification of refractory patients to be switched to rescue therapy. Treatment should be risk-adapted. Recent studies are linking specific characteristics of the plasma cell clone to response to different types of treatment, moving toward patient-tailored therapy. In addition, novel anti-amyloid treatments are being developed that might be combined with anti-plasma cell chemotherapy.
authors.affiliation: Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy.
authors.forename: Giovanni
authors.identifier: 0000-0001-5994-5138
authors.initials: G
authors.lastname: Palladini
authors.affiliation: Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy.
authors.forename: Giampaolo
authors.identifier: 0000-0001-7680-3254
authors.initials: G
authors.lastname: Merlini
mesh_terms: D000686:Amyloidosis / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains; D008297:Male
chemical_list: D015415:Biomarkers; D007147:Immunoglobulin Light Chains