Abstract Background Immunoglobulin light chain (AL) amyloidosis is a well-recognized complication of multiple myeloma (MM), with a significant impact on prognosis. However, the effect of cardiac AL amyloidosis on survival in MM patients has been rarely investigated. Purpose We aimed to perform a systematic review and meta-analysis to quantitatively assess the prognosis of MM patients with and without concomitant cardiac AL amyloidosis. Methods We searched PubMed, Scopus and Cochrane databases for studies comparing the survival of MM patients with and without concomitant cardiac AL amyloidosis. The primary outcome was all-cause mortality at 12 months (short-term), while secondary outcomes included all-cause mortality at 24 and 36 months (long-term). Heterogeneity was assessed with I2 statistics. We pooled risk ratios (RR) with 95% confidence intervals (CI) using a random-effects model. Results We included five studies encompassing 264 patients, of whom 109 (41%) presented MM with concomitant cardiac AL amyloidosis. All-cause mortality at 12 months was nearly five times higher in MM patients with cardiac involvement compared to those without cardiac involvement (RR 4.73; 95% CI 1.82-12.27; p=0.001). This trend remained consistent at long-term follow-up, with increased mortality observed in patients with cardiac involvement at 24 months (RR 1.87; 95% CI 1.17-3.00; p=0.009) and 36 months (RR 1.82; 95% CI 1.22-2.73; p=0.004), although with a lower magnitude of effect. Conclusion These findings suggest that the presence of cardiac AL amyloidosis in patients with MM is a key determinant of survival.
Stabile et al. (Fri,) studied this question.
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