Diagnostic features and treatment approaches for AL amyloidosis: a literature review and clinical case report

AL amyloidosis (ALA) is a disease characterized by the deposition of immunoglobulins monoclonal free light chains fragments with impaired organ function. Despite advances in the treatment of plasma cell dyscrasias, determining optimal approaches to treating ALA patients remains a challenging task. Research results and real-world clinical practice data indicate the advantage of using a combination of daratumumab with a bortezomib-containing regimen over other programs in achieving an antitumor response, increasing progression-free survival, while remaining a highly effective treatment option with a favorable safety profile in most patients. It is advisable to study the prognostic role of minimal residual disease in ALA patients and its correlation with the achieved hematological and organ responses at different treatment stages, as well as to search for new biological markers for patients’ risk stratification and optimization of antitumor therapy.

Clinical case of a patient with stage II ALA are presented. After six cycles of Dara-VCD (daratumumab, bortezomib, cyclophosphamide, and dexamethasone), a very good partial hematologic response was recorded. Despite the fact that the patient had previously received VCD (bortezomib, cyclophosphamide, and dexamethasone) and daratumumab alone in the second line, significant treatment efficacy, along with a significant improvement in overall condition and quality of life, was achieved only with the use of bortezomib-containing therapy in combination with an anti-CD38 antibody.