Bad players in AL amyloidosis in the current era of treatment

Area of Science:

• Hematology
• Oncology
• Cardiology

Background:

• Systemic AL amyloidosis (ALA) is a plasma cell disorder with poor prognosis, historically linked to cardiac involvement.
• Current prognostic models rely on cardiac markers and dFLC, but cardiac biomarkers lack specificity and are influenced by other factors.
• Recent therapeutic advances have significantly improved patient outcomes in ALA.

Purpose of the Study:

• To provide an updated review on the prognostic significance of cardiac involvement in ALA.
• To discuss the role of novel diagnostic and prognostic markers, including imaging and biological markers.
• To highlight the impact of modern therapies and minimal residual disease (MRD) assessment on ALA prognosis.

Main Methods:

• Literature search conducted in PubMed and Google Scholar.
• Inclusion of recent and relevant data on ALA prognosis, treatment response, and biomarkers.
• Focus on advancements in cardiac imaging (ECHO, MRI) and biological markers.

Main Results:

• Cardiac involvement remains a key prognostic factor in ALA.
• Newer imaging modalities like ECHO and MRI provide more precise cardiac assessment.
• Emerging biological markers related to cardiac injury, inflammation, and endothelial damage show promise.
• Minimal residual disease (MRD) assessment is crucial for evaluating treatment response.

Conclusions:

• Modern therapies have transformed ALA prognosis.
• Advanced cardiac imaging and novel biomarkers offer improved risk stratification.
• Prospective multicenter trials are needed to refine risk assessment models in the current therapeutic landscape.