Newer Investigational Approaches

In view of the activity of several new agents in myeloma, these agents are now also being tested in patients with AL amyloidosis. However, the tolerance to drugs such as thalidomide is lower in this patient population.58 Based on its binding to amyloid fibrils in vivo, iododeoxydoxorubicin was tested in a phase I/II trial, but yielded a low (15%) response rate as a single agent.59 Hrncic et al. reported on an experimental model in which injection of antibody directed against amyloidogenic light chains led to regression of amyloid deposits.60 This has not yet been tested in humans. Another approach in early clinical testing involves targeted pharmacologic depletion of serum amyloid P component, which may have broad utility in several amyloid states.61

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