[Prognostic factors in light-chain cardiac amyloidosis: a retrospective analysis]

Area of Science:

• Cardiology
• Hematology
• Oncology

Background:

• Amyloid light-chain (AL) amyloidosis is a plasma cell disorder causing amyloid deposition in organs.
• Cardiac involvement in AL amyloidosis is a known predictor of poor survival.
• Limited prognostic indicators exist that comprehensively assess organ involvement and patient condition.

Purpose of the Study:

• To identify prognostic factors for AL amyloidosis.
• To evaluate the impact of cardiac involvement on survival in AL amyloidosis patients.
• To inform treatment strategies and palliative care decisions.

Main Methods:

• Retrospective review of 27 AL amyloidosis patients diagnosed between 2012 and 2019.
• Analysis of survival rates based on cardiac involvement.
• Identification of clinical and laboratory parameters associated with poor prognosis.

Main Results:

• The 3-year overall survival rate was 20% for patients with cardiac involvement versus 85.7% for those without (p=0.021).
• Poor prognostic factors included low left ventricular ejection fraction, low hemoglobin, elevated NT-proBNP and BNP, high difference free light chains, advanced NYHA class, Mayo stage IV disease, and cardiac amyloidosis.
• Four non-survivors within 6 months all had cardiac amyloidosis, Mayo stage IV disease, and insufficient chemotherapy.

Conclusions:

• Cardiac amyloidosis is a critical factor associated with poor prognosis in AL amyloidosis.
• Multiple factors including cardiac status, hematologic markers, and disease stage predict survival.
• Careful treatment planning, including palliative care, is essential for patients with poor prognostic indicators in AL amyloidosis.