Exploring Diagnostic Approaches for Patients with Light Chain Amyloidosis

Opinion
Video

A panel of oncology experts offer insights into the diagnosis of AL amyloidosis, emphasizing the difficulties associated with early detection.

This is a video synopsis/summary of a Peer Exchange involving Heather Landau, MD; Vaishali Sanchorawala, MD; and Jeffrey Zonder, MD.

Panelists provide crucial insights into diagnosing light chain (AL) amyloidosis. Initial diagnostic steps include ordering serum protein electrophoresis, immunofixation, and serum-free light chains. For patients with monoclonal gammopathy of undetermined significance, cardiac biomarkers like NT-proBNP and troponin are recommended. Essential tests include a 24-hour urine analysis, echocardiogram, and electrocardiogram. A bone marrow biopsy is pivotal, detecting amyloid in about 60% of cases. The experts stress the importance of considering surrogate site biopsies, like a fat pad aspirate or organ biopsy, especially with rising cases of transthyretin amyloid.

The panelists highlight the critical role of tissue diagnosis, emphasizing Congo red dye as the gold standard but warning about potential false results. They emphasize that although high-volume centers may need directed organ biopsies in 10% of cases, considering ATTR amyloidosis is vital, given its characteristics and potential overlap with plasma cell disorders. They stress the need for vigilance in detecting diverse types of amyloidosis, ensuring accurate diagnoses in this complex landscape. Health care professionals should remain attentive to potential ATTR amyloidosis, even in patients with positive protein electrophoresis or free light chain assays.

Video synopsis is AI-generated and reviewed by OncLive® editorial staff.

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