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Clinical features, laboratory characteristics and outcomes of patients with renal versus cardiac light chain amyloidosis
Author(s) -
Sidana Surbhi,
Tandon Nidhi,
Gertz Morie A.,
Dispenzieri Angela,
RamirezAlvarado Marina,
Murray David L.,
Kourelis Taxiarchis V.,
Buadi Francis K.,
Kapoor Prashant,
Gonsalves Wilson,
Warsame Rahma,
Lacy Martha Q.,
Kyle Robert A.,
Rajkumar S. Vincent,
Kumar Shaji K.,
Leung Nelson
Publication year - 2019
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15832
Subject(s) - medicine , amyloidosis , cardiac amyloidosis , al amyloidosis , immunoglobulin light chain , cardiology , immunology , antibody
Summary This study evaluated the differences in clinical features of 1077 newly diagnosed AL amyloidosis patients with renal involvement ( n = 229, 21%), both cardiac and renal involvement ( n = 443, 41%) and cardiac involvement ( n = 405, 38%). Significant differences in dFLC (difference in involved and uninvolved light chains) were noted (renal, both, cardiac median: 83, 234 and 349 mg/l, P < 0.001). The proportion of patients with ≥ 10% bone marrow plasma cells ( BMPC s) was lowest in renal only patients: 44%, 57%, 64%, respectively, P < 0.001. In a multivariate linear regression model incorporating organ involvement type and BMPC s ≥10%, organ involvement was a significant predictor of dFLC ( P < 0.001). Median overall survival ( OS ) across the three groups was 83 vs. 19 vs. 16 months ( P < 0.001) in patients not undergoing transplant and 5‐year OS in patients undergoing transplant was 90% vs. 75% vs. 64% ( P = 0.007), respectively. In conclusion, renal involvement alone or renal + cardiac involvement in AL amyloidosis is associated with lower circulating light chain burden, which cannot be fully explained by BMPC burden alone. Increased sensitivity of the kidney to light chains, given significant interactions with the renal tubular system and secretion of modified light chain products may play a role in pathogenesis of renal AL amyloidosis and warrants further investigation.