Among cases of amyloid light-chain (AL) amyloidosis, cardiac amyloidosis is particularly known to be associated with a poor prognosis. However, a few established prognostic indicators exist that consider other organ involvements and a patient's general condition. Between 2012 and 2019, we retrospectively reviewed 27 patients, who were diagnosed with AL amyloidosis at our hospital. The 3-year overall survival rate of patients with cardiac involvement was 20% (95% confidence interval [CI], 0.035-0.461) and that of patients without cardiac involvement was 85.7% (95%CI, 0.334-0.979) (p=0.021). Poor prognostic factors of AL amyloidosis included left ventricular ejection fraction <60%, hemoglobin < 10 g/dl, NT pro-BNP>1,800 pg/ml, BNP>400 pg/ml, difference free light chains>180 mg/l, New York Heart Association classification ≥3, Mayo stage IV disease, and cardiac amyloidosis. A study on four patients who died within 6 months of diagnosis revealed that all the patients had cardiac amyloidosis and Mayo stage IV disease, and they all did not receive sufficient chemotherapy. Although the number of treatment options for AL amyloidosis is expected to increase in the future, patients with poor prognostic factors have a poor prognosis and careful treatment decisions, including palliative care, are required.
Keywords: AL amyloidosis; Cardiac amyloidosis; Prognostic factors.