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EHA 2025 | Hidden light chain amyloidosis in patients with multiple myeloma
Ashutosh Wechalekar, MBBS, MD, FRCP, FRCPath, DM, University College London Hospitals NHS Foundation Trust, London, UK, addresses the potential issue of hidden light chain amyloidosis in patients with multiple myeloma. He emphasizes the importance of considering amyloidosis as a potential differential diagnosis in patients with myeloma who develop organ dysfunction, as it may impact treatment choices. This interview took place at the 30th Congress of the European Hematology Association (EHA) in Milan, Italy.
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Transcript
Yes, I think we went through a variety of different things in the session this morning on amyloidosis. We talked about the fact that amyloidosis is a difficult diagnosis. There is an overlap between amyloidosis and myeloma. The vast majority of patients with amyloidosis will not have myeloma, but there will be a proportion of patients who do have myeloma. There are patients with myeloma who may have incipient amyloid, who may not have symptoms of presentation, but as myeloma patients are living longer, especially patients who don’t achieve a complete response, can develop organ progression and may develop amyloid...
Yes, I think we went through a variety of different things in the session this morning on amyloidosis. We talked about the fact that amyloidosis is a difficult diagnosis. There is an overlap between amyloidosis and myeloma. The vast majority of patients with amyloidosis will not have myeloma, but there will be a proportion of patients who do have myeloma. There are patients with myeloma who may have incipient amyloid, who may not have symptoms of presentation, but as myeloma patients are living longer, especially patients who don’t achieve a complete response, can develop organ progression and may develop amyloid. So if you have a myeloma patient who unexpectedly develops heart failure, unexpectedly develops neuropathy, unexpectedly develops proteinuria, please think of amyloidosis as a potential differential diagnosis because it may change how you use the drug. It may change where your treatment outcomes are. We also touched upon the fact that patients with AL amyloidosis at presentation may have a varying amount of plasma cell infiltration from 1% to 30, 40, 50%. And patients who present more towards the myeloma end of the spectrum may have to be treated more like patients with true myeloma rather than true amyloidosis. And the patients in between, we need to learn a little bit more about where they might behave, the biology of the disease, such as flow cytometry to decide if they have got an MGUS-like phenotype or a myeloma-like phenotype, which seems to be important in myeloma prognosis. Or the genetics, like if they have a 1q gain or if they have other high-risk parameters, may require more intensive therapy rather than just simple myeloma treatments.
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