Outcomes of Patients With AL Amyloidosis and End‐Stage Renal Disease After Initiation of Therapy

In AL amyloidosis, advanced renal disease can impact treatment options and cause significant morbidity. Patients with ESRD requiring dialysis are a group with currently unmet needs. In this collaborative study, we identified 362 patients from three European centers who initiated dialysis during the course of the disease. Median survival after the initiation of dialysis was 40 months. Heart involvement, higher BMPC infiltration at diagnosis, and lambda light chain type were associated with inferior survival. At the time of dialysis initiation, cardiac biomarkers were prognostic for postdialysis outcome, but they did not perform the same as in patients not on dialysis. Higher FLCs levels at dialysis initiation were also prognostic, independently of cardiac biomarkers and other adverse factors. After starting dialysis, 151 patients received further treatment; median postdialysis survival for those that achieved CR/VGPR was significantly improved with 63.8 vs. 42 months for patients who achieved PR or less. In conclusion, patients with AL amyloidosis that require dialysis still represent a group of patients with poor outcomes, although, they can have prolonged postdialysis survival if they achieve deep hematologic response and have limited cardiac and clonal disease; such patients could also be considered for renal transplantation.