ABSTRACT
The potential utility of serum free light chain measurements for assessing response to chemotherapy in AL amyloidosis was studied in a retrospective analysis of 164 patients. Patients received high-, intermediate-or low-dose treatments, and all were monitored on a six-monthly basis. Stored blood samples were analysed for serum free light chains in the 137 patients who survived at least six months. Results showed that a reduction in the amyloidogenic free light chains by 50 percent or more, following chemotherapy, was associated with a 10-fold survival advantage. AL amyloidosis patients with symptomatic myocardial involvement were given chemotherapy and monitored for serum free light chains and N-terminal pro-natriuretic peptide type B (NT-proBNP), a sensitive marker of myocardial dysfunction. During treatment, 11 of the patients had a reduction of serum free light chains by more than 50 percent. In all of the 11 patients there was a corresponding reduction of NT-proBNP levels and in six, the heart failure resolved.
