INTRODUCTION: Symptomology of AL Amyloidosis can be vague, with a broad range of manifestations and potential etiologies. We sought to determine whether time from initial patient-reported symptom onset to diagnosis was associated with survival. METHODS: The Boston University Amyloidosispatient Database was queried for patients with AL Amyloidosis who presented to the Center for initial evaluation from 2010 to 2015. RESULTS: A total of 324 patients with AL Amyloidosis were evaluated for initial evaluation. The median time to diagnosis from initial symptom onset was 7.1 months (range, 0-61). At data cutoff, 60.2% (n = 195) of patients were alive; of those, the majority were diagnosed <6 months from initial symptoms (52.3%, n = 102). In contrast, time to diagnosis from symptom onset was >6 months in 63.6% (n = 82) of patients who did not survive at the time of data cutoff (P = .0005). Survival analysis of time from diagnosis to death or data cutoff stratified by time from patient-reported symptom onset to diagnosis (<6, 6-12, and >12 months) showed significant differences among groups (P = .001). Additionally, multivariable regression demonstrated that an increase in time from self-reported symptom onset to diagnosis was significantly associated with an increased risk of death (HR = 1.02, 95% CI = 1.01-1.04, P = .002). CONCLUSION: These results support the importance of early diagnosis for patients with AL Amyloidosis.
Desport E, Bridoux F, Sirac C, et al. AL Amyloidosis. Orphanet JRare Dis. 2012;7(1):54.
Sanchorawala V. Light-Chain (AL) amyloidosis: diagnosis and treatment. Clin J Am Soc Nephrol. 2006;1(6):1331-1341.
National Organization for Rare Disorders. Amyloidosis - NORD, [Internet]. NORD (National Organization for Rare Disorders). [cited 2020 May 12]. Available from: https://rarediseases.org/rare-diseases/amyloidosis/
Comenzo R, Reece D, Palladini G, et al. Consensus guidelines for the conduct and reporting of clinical trials in systemic light-chain amyloidosis. Leukemia. 2012;26(11):2317-2325.
Kyle R, Linos A, Beard C, et al. Incidence and natural history of primary systemic amyloidosis in Olmsted County, Minnesota, 1950 through 1989 [see comments]. Blood. 1992;79(7):1817-1822.
Pinney J, Smith C, Taube J, et al. Systemic amyloidosis in England: an epidemiological study. Br J Haematol. 2013;161(4):525-532.
Kyle RA, Linos A, Beard CM, et al. Incidence and Epidemiology of Primary Systemic Amyloidosis (AL) in Olmsted County, Minnesota: 1950 Through 1989. Amyloid and Amyloidosis. Blood. 1950;1990:211-214.
Quock T, Yan T, Chang E, Guthrie S, Broder M. Epidemiology of AL amyloidosis: a real-world study using US claims data. Blood Adv. 2018;2(10):1046-1053.
Amyloidosis Foundation.AL - Amyloidosis Foundation [Internet]. [cited 2020 May 12]. Available from: https://amyloidosis.org/facts/al/
Lachmann H, Goodman H, Gilbertson J, et al. Natural history and outcome in systemic AA amyloidosis. N Engl J Med. 2007;356(23):2361-2371.
Ando Y, Coelho T, Berk J, et al. Guideline of transthyretin-related hereditary amyloidosis for clinicians. Orphanet J Rare Dis. 2013;8(1):31.
Muchtar E, Buadi F, Dispenzieri A, Gertz M. Immunoglobulin Light-Chain amyloidosis: from basics to new developments in diagnosis. prognosis and therapy. Acta Haematol. 2016;135(3):172-190.
Wechalekar A, Gillmore J, Hawkins P. Systemic amyloidosis. Lancet. 2016;387(10038):2641-2654.
Gertz M. Immunoglobulin light chain amyloidosis: 2014 update on diagnosis, prognosis, and treatment. Am J Hematol. 2014;89(12):1132-1140.
Kumar S, Gertz M, Lacy M, et al. Recent improvements in survival in primary systemic amyloidosis and the importance of an early mortality risk score. Mayo Clin Proc. 2011;86(1):12-18.
Badar T, D'Souza A, Hari P. Recent advances in understanding and treating immunoglobulin light chain amyloidosis. F1000Res. 2018;7:1348.
Muchtar E, Gertz M, Kumar S, et al. Improved outcomes for newly diagnosed AL amyloidosis between 2000 and 2014: cracking the glass ceiling of early death. Blood. 2017;129(15):2111-2119.
McCausland K, White M, Guthrie S, et al. Light Chain (AL) amyloidosis: the journey to diagnosis. Patient. 2017;11(2):207-216.
Lousada I, Comenzo R, Landau H, Guthrie S, Merlini G. Patient experience with light chain amyloidosis: a survey from the amyloidosis research consortium. J Cardiac Fail. 2015;21(8):S63.
Lilleness B, Ruberg F, Mussinelli R, Doros G, Sanchorawala V. Development and validation of a survival staging system incorporating BNP in patients with light chain amyloidosis. Blood. 2019;133(3):215-223.
Palladini G, Hegenbart U, Milani P, et al. A staging system for renal outcome and early markers of renal response to chemotherapy in AL amyloidosis. Blood. 2014;124(15):2325-2332.
Sher T, Hayman SR, Gertz MA. Treatment of primary systemic amyloidosis (AL): role of intensive and standard therapy. Clin Adv Hematol Oncol. 2012;10(10):644-651.
Dispenzieri A, Buadi F, Reeder C, et al. Treatment of immunoglobulin light chain amyloidosis: mayo stratification of myeloma and risk-adapted therapy (mSMART) consensus statement. Mayo Clin Proc. 2015;90(9):1054-1081.
Weiss BM, Lund SH, Bjorkholm M, et al. Improved survival in AL amyloidosis: a population-based study on 1,430 patients diagnosed in Sweden 1995-2013. Blood. 2016;128(22):4448.
Warsame R, Kumar S, Gertz M, et al. Abnormal FISH in patients with immunoglobulin light chain amyloidosis is a risk factor for cardiac involvement and for death. Blood Cancer J. 2015;5(5):e310.
Vaxman I, Gertz M. Recent advances in the diagnosis, risk stratification, and management of systemic light-chain amyloidosis. Acta Haematol. 2019;141(2):93-106.
Varga C, Titus S, Toskic D, Comenzo R. Use of novel therapies in the treatment of light chain amyloidosis. Blood Rev. 2019;37:100581.
Milani P, Merlini G, Palladini G. Novel therapies in light chain amyloidosis. Kidney Int Rep. 2018;3(3):530-541.
Joseph N, Kaufman J. Novel approaches for the management of AL amyloidosis. Curr Hematol Malig Rep. 2018;13(3):212-219.
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/The Amyloidosis Center database and repository are supported by Amyloid Research Fund of Boston University School of Medicine