Evaluation Of Response

Evaluation of response to therapy in AL amyloidosis is largely based on surrogate measures that assess improvement in the underlying plasma cell clone and in AL-related organ dysfunction.39 The hematologic response definition is quite comparable to that used in multiple myeloma, though the level of the monoclonal Ig in AL is quite low compared to myeloma. Most AL treatment centers also follow serum levels of free light chains as surrogate markers,40 although this assay has not yet been fully incorporated or compared with the traditional response criteria used in most published studies with AL amyloid. Currently, improvement in AL-related organ dysfunction remains the gold standard by which the clinical efficacy of therapies against AL amyloid is judged. Although a consensus is beginning to emerge, these criteria are somewhat arbitrary. It is notable that histologic evidence of regression of AL deposits has not been documented in most studies. Indeed, improved organ function can occur without actual regression of amyloid deposits.21

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