DESPITE advances in therapy, systemic light chain (AL) amyloidosis remains a diagnostic challenge, with a median delay of six months from initial symptoms to diagnosis, according to new data presented at the 2025 COMy (Controversies in Multiple Myeloma) Congress.
Researchers retrospectively analysed data from 114 patients diagnosed with AL amyloidosis at two academic institutions between 2007 and 2024. The findings highlighted that symptoms such as bilateral carpal tunnel syndrome, arthritis, and neuropathy were linked to the longest diagnostic delays (up to 156 months) underscoring significant missed opportunities for earlier detection.
At diagnosis, over half the patients had involvement of three or more organs. Cardiac involvement was particularly prevalent, affecting 73% of patients. Among them, 50% had severe heart disease, and one-third of these died within six months of diagnosis.
Histological confirmation was achieved in all but one patient, most commonly via biopsy of abdominal fat, skin, salivary gland or bone marrow. Lambda light chain monotype was dominant, and marrow infiltration exceeding 10% was seen in half of the cases.
The study also examined the impact of daratumumab, which has been incorporated into standard treatment regimens in recent years. When used earlier, daratumumab contributed to deeper haematological responses, with 43% of patients achieving complete or very good partial responses.
While treatment options have improved, researchers stress that timely diagnosis remains critical. They call for increased awareness and faster recognition of the disease to prevent irreversible organ damage and improve survival outcomes.
Reference
Vekemans MC et al. Real-life experience on light chain cardiac amyloidosis: delay in diagnosis is still a major issue. COMy 2025.
