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?

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:

1. Understand...

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...

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, ...