Charting the future of AL amyloidosis: Diagnostic advancements, prognostic insights, and therapeutic challenges.

Abstract

Light-chain (AL) amyloidosis is a clonal plasma cell dyscrasias, which leads to abnormal dermatologic, musculoskeletal, connective tissue manifestations, and the progressive multi-organ dysfunction. Currently, the diagnostic workflow for AL amyloidosis remains complex and resource-intensive, highlighting the need for novel diagnostic approaches to expedite the process, optimize resource utilization, and reduce diagnostic delays. Furthermore, prognostic evaluation in AL amyloidosis also requires continuous refinement to align with evolving diagnostic and therapeutic advancements. While patient outcomes have improved significantly following the widespread implementation of daratumumab-based regimens, several therapeutic challenges persist in AL amyloidosis management, including undefined optimal daratumumab combinations, variable treatment duration, etc. This review provides a comprehensive synthesis of current diagnostic advancements, novel prognostic insights, and potential solutions for therapeutic challenges in AL amyloidosis, with particular focus on daratumumab-era management optimization strategies to advance clinical practice.