AL Amyloidosis

Although AL amyloidosis is not cancer, it is treated similarly to a blood cancer called myeloma. This is because both AL amyloidosis and myeloma are caused by abnormal plasma cells produced in the bone marrow.

Chemotherapy medicines are used to kill the plasma cells or stop them from multiplying and spreading in the body. Some examples of chemotherapy medicines for AL amyloidosis are cyclophosphamide and melphalan. These medicines have been used to treat AL amyloidosis for a very long time and their effectiveness and safety have been well established.

These are a class of medicines that have been used in AL amyloiodsis for about the last 10 to 15 years. Pls help trigger one of the body’s natural processes of killing cells; by doing this, the abnormal plasma cells that are multiplying and spreading uncontrollably are able to be targeted and destroyed by the body.

Because they help significantly reduce the amount of abnormal plasma cells, PIs have brought great improvements in patient response to treatment and survival. The main PI given in the UK is bortezomib (Velcade®) which can be given as an injection into the vein or under the skin.

These are drugs that help slow down growth and multiplication of the abnormal plasma cells, and support the immune system in fighting the disease. Lenalidomide (Revlimid®) is available as a capsule and is the most commonly used IMiD in the UK.

A mab is a medicine that targets and sticks to the abnormal plasma cell and kills it, and also helps the immune system fight the disease. Daratumumab (Darzalex®) is the mab used to treat AL amyloidosis in the UK and can be given via a drip or an injection under the skin.

Steroids are always prescribed in conjunction with one or more of the above drugs in the treatment of AL amyloidosis. They help strengthen the effect of these medicines. Steroids are usually prescribed as tablets.

ASCT is another treatment option for AL amyloidosis patients. This can be a long and challenging process and is therefore usually appropriate only for those who have been diagnosed early and are in relatively good health. The first stage involves collecting or ‘harvesting’ your stem cells. The word ‘autologous’ refers to a persons own cells (as opposed to using cells from another person). Before the harvest you’ll be given some medicine to boost the number of stem cells in your blood, and about 5 days later you’ll have a blood test to see if there are enough stem cells in your blood, and if there are, the harvest will begin. You’ll have a needle inserted in a vein in each arm, and tubes like those used for a drip will connect you to a cell separator machine (that looks a bit like a dialysis machine). The cell separator draws out the blood from your one of your arm veins, passes it through a filter that ‘catches’ the stem cells, and then returns the blood to you via the other arm. This procedure usually lasts a few hours, and may be repeated the next day if there weren’t enough stem cells collected on the first attempt. This process may sound scary and invasive but it is painless and apart from nurses and doctors buzzing around, you should be able to read a book or watch a film while its going on. Stage two of the process can be more challenging. Here you will be given a regimen of high-dose chemotherapy to kill the abnormal plasma cells in the bone marrow. High-dose melphalan is the medicine of choice for ASCT as is highly effective at killing the abnormal cells. However, melphalan will also kill healthy cells in the bone marrow which weakens the immune system, making you more prone to infections. During this period when your immune system is low, you’ll be advised to mimimise contact with other people as you’ll be susceptible to infection, and even the mildest infection could make you quite sick. Your doctor may prescribe protective antibiotics to lower your risk of infection during this time and until your immune system is back to normal. The final stage of ASCT involves transplanting or returning your stem cells into your bloodstream through a drip via a vein. This is usually a painless process and can take a few hours. Once your stem cells reach your bone marrow they will start to make new cells, and that can happen over a period of about two weeks. For more information about treatments for AL amyloidosis see the Myeloma UK and Amyloidosis Research Consortium websites.