Impact of renal impairment on light chain amyloidosis outcomes after autologous hematopoietic stem cell transplantation

Light chain amyloidosis (AL) is a rare clonal plasma cell neoplasm characterized by the deposition of amyloid fibrils derived from the aggregation of misfolded immunoglobulin light chains in vital organs such as heart and kidneys resulting in irreversible organ damage (1). The severity of organ damage is the most important determinant of outcome. Both cardiac and renal staging systems have been proposed and validated as predictors of outcome. Cardiac staging system, initially developed and then revised by the Mayo Group, utilizes cardiac biomarkers (NT-proBNP, troponin T and I) and serum free light chain levels to stratify the patients (2,3). Renal staging system, developed by the Pavia Group, depends on the degree of proteinuria and glomerular filtration rates (GFRs) (4). Cardiac stage in general is a predictor of non-relapse mortality and overall survival, while renal stage is a predictor of renal recovery and dialysis dependence (2-4). Renal involvement is seen in approximately 70% of patients with AL (5). However, there are limited data on the impact of baseline renal dysfunction on the outcomes of AL after autologous stem cell transplantation (ASCT).