How would you approach management and monitoring of AL amyloidosis with isolated renal involvement?
AL amyloid biopsy proven on renal biopsy. Normal SPEP and FLC, bone marrow biopsy with 10-15% plasma cells.
Answer from: Medical Oncologist at Academic Institution
This is tough for sure, and my first question would be to ask how the renal biopsy was determined to be AL amyloidosis. Sometimes typing isn't required if the pattern is overwhelmingly lambda-restricted or kappa-restricted by immunofluorescence... but in this case, mass spectrometry typing may be wo...
Comments
Medical Oncologist at Mayo Clinic Rochester Completely agree with @Rahul Banerjee! Biopsy prov...
Medical Oncologist at Winship Cancer Institute of Emory University I've never seen typing of an amyloid kidney, altho...
Medical Oncologist at Loyola University Medical Center In terms of things I hate with a passion, it looks...
Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center Very well stated @Patrick A. Hagen - as much as I ...
Answer from: Medical Oncologist at Academic Institution
Assuming the diagnosis is correct, my preference is to approach management with Dara-CyBorD induction as in ANDROMEDA followed by Dara maintenance. Upfront ASCT is reasonable in cases of renal-only amyloidosis, though with 10-15% disease, I would favor induction anyhow.For disease monitoring, 24-hou...
Comments
Medical Oncologist at Winship Cancer Institute of Emory University I like this pathway for AL amyloidosis, although m...
Completely agree with @Rahul Banerjee! Biopsy prov...
I've never seen typing of an amyloid kidney, altho...
In terms of things I hate with a passion, it looks...
Very well stated @Patrick A. Hagen - as much as I ...