Amyloidosis
AL, ATTR and AA amyloid, the red flags that should prompt a light chain screen, why tissue typing matters when a monoclonal protein and a positive bone scan coexist, Mayo cardiac staging, and daratumumab with CyBorD (PBS) for AL.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Extracellular deposits of misfolded protein in beta-pleated sheets. Over 40 precursor proteins are recognised, but three cover nearly all systemic disease: AL, ATTR and AA.
- AL is a plasma cell disorder and a medical emergency when the heart is involved. The clone is usually small (median marrow plasma cells about 10%), so think of it as a monoclonal gammopathy of clinical significance.
- Wild-type ATTR is now the commonest type diagnosed, mostly cardiac in older men. Its cardiology lives in restrictive cardiomyopathy and cardiac amyloidosis.
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Sources
- Analysis of daratumumab for newly diagnosed systemic light chain amyloidosis (DUSC public release document)AU/NZPharmaceutical Benefits Advisory Committee, Drug Utilisation Sub-Committee, October 2025
- Guidelines for non-transplant chemotherapy for treatment of systemic AL amyloidosis: EHA-ISA working groupWechalekar AD et al., Amyloid 2023;30:3-17, 2022
- Daratumumab-based treatment for immunoglobulin light-chain amyloidosis (ANDROMEDA)Kastritis E et al., N Engl J Med 2021;385:46-58, 2021
- AL amyloidosis: current chemotherapy and immune therapy treatment strategies (JACC: CardioOncology state-of-the-art review, includes transplant eligibility criteria)Bianchi G, Zhang Y, Comenzo RL, JACC CardioOncol 2021;3:467-87, 2021
- Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial DiseasesGarcia-Pavia P et al., Eur Heart J 2021;42:1554-68, 2021
- Amyloid nomenclature 2022: update, novel proteins, and recommendations by the International Society of Amyloidosis (ISA) Nomenclature CommitteeBuxbaum JN et al., Amyloid 2022;29:213-19, 2022
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy