How extensive of a workup do you do for systemic AL amyloidosis for a patient with a resected amyloidoma, localized AL amyloid deposition in their airway or lungs, who has no other symptoms?

Topics: Hematologic Malignancies • Medical Oncology • Myeloma • NCI-CCC Tumor Board Question • Amyloidosis • University of Washington • NCI-CCC Myeloma Tumor Board Question • Multiple Myeloma

Would you do a 24-hour urine and echocardiogram in all of these patients? Cardiac biomarkers, PT/PTT, or any other such blood tests?

Answer from: Medical Oncologist at Community Practice

It's common to over-test in these patients. We in hematology/oncology, often order bone marrow biopsies, PET/CTs, and cardiac MRIs without realizing that each test costs around $10,000 and can potentially harm the patient.Here are two points to assist with the work-up for these patients: Understa...

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Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center
EXCELLENTLY stated words of wisdom! I'd sheepishly...

Answer from: Medical Oncologist at Academic Institution

I will assume that localized AL amyloidosis refers to the fact that a bone marrow biopsy was performed which showed no monoclonal plasma cell population and imaging did reveal plasmacytoma. I think this is key to the workup to ensure there is no evidence of a systemic disease process.The site of the...

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Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center
This is EXCELLENT and very helpful! Thanks, Dr. @D...

Answer from: Medical Oncologist at Academic Institution

I'm usually cautious when making decisions in this scenario. However, having amyloidosis in the lung could raise concerns about systemic disease. As a result, I tend to conduct a thorough workup, even if the patient is asymptomatic, to rule out systemic disease. This includes blood and urine tests, ...

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