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AL Amyloidosis and Blood Cancers: Understanding the Connection

Posted on April 20, 2021
Medically reviewed by
Todd Gersten, M.D.
Article written by
Maureen McNulty

  • Amyloid light-chain (AL) amyloidosis is not a type of cancer, but it sometimes occurs at the same time as certain blood cancers.
  • Multiple myeloma, Hodgkin lymphoma, and non-Hodgkin lymphoma are types of blood cancer that can lead to the development of AL amyloidosis.
  • AL amyloidosis and blood cancers can sometimes be managed with the same treatments.

AL amyloidosis, also called amyloid light-chain amyloidosis, sometimes occurs alongside other diseases — including blood cancers such as multiple myeloma and lymphoma. Amyloidosis is often a complication of these cancers. A complication is a condition that occurs during or after an existing disease or its treatment.

AL amyloidosis may also be comorbid with blood cancers. Comorbidities are two diseases that occur at the same time. Having a comorbidity or complication can sometimes make diseases more difficult to diagnose and treat. If you have both AL amyloidosis and blood cancer, it is important to address both conditions in order to have a better prognosis and support your overall health and quality of life.

Is Amyloidosis a Type of Cancer?

Specialists don’t consider amyloidosis to be a form of blood cancer. However, there is some overlap between these conditions. AL amyloidosis is caused by specific blood cells that may also be involved in cancer. Additionally, AL amyloidosis and blood cancers may be treated with some of the same therapies.

Causes of AL Amyloidosis vs. Blood Cancers

AL amyloidosis is caused by abnormal plasma cells. Plasma cells are a part of the immune system. They are usually found in the bone marrow, a type of tissue found inside of certain bones. When the body encounters germs, such as bacteria or viruses, a type of white blood cell called a B cell transforms into a plasma cell. Normal plasma cells make antibodies — proteins that kill germs and protect the body. The antibodies, also called immunoglobulins, are made up of two parts: heavy chains and light chains. In AL amyloidosis, plasma cells make abnormal immunoglobulin light chains. These proteins clump together, forming amyloid fibrils that build up in the body.

Whereas AL amyloidosis develops when blood cells make amyloid proteins, blood cancer develops when blood cells grow out of control. This uncontrolled growth generally happens after a cell develops multiple genetic changes. You can be born with these changes, but they usually happen over the course of your life. The gene changes make cells grow and produce new cells too quickly. While blood cancers cause high levels of abnormal cells, people with amyloidosis generally have lower levels of abnormal plasma cells than people with blood cancers.

Why do these two conditions sometimes occur together? Because of their many gene changes, cancer cells sometimes produce amyloid proteins, leading to amyloidosis. In this case, AL amyloidosis is a complication of the original blood cancer. It is important to note, however, that having a blood cancer doesn’t necessarily mean that you will develop amyloidosis. Amyloidosis is still rare, even among people with cancer.

Treatments for AL Amyloidosis vs. Blood Cancers

AL amyloidosis is often treated with the same medications used to treat multiple myeloma or lymphoma. For both types of conditions, the goal of treatment is to kill abnormal blood cells.

AL amyloidosis can be treated with drugs used in multiple myeloma treatment, including:

  • Cytoxan (cyclophosphamide)
  • Velcade (bortezomib)
  • Alkeran (melphalan)
  • Revlimid (lenalidomide)
  • Ozurdex (dexamethasone)
  • Darzalex (daratumumab)

A stem cell transplant can also be used to treat some cases of AL amyloidosis. During this procedure, a person’s abnormal plasma cells are destroyed using high-dose chemotherapy. Then, the person is given an infusion of healthy stem cells, which make all of the other cell types found in the blood. A stem cell transplant can also help treat blood cancers that occur along with amyloidosis.

Blood Cancers Associated With AL Amyloidosis

AL amyloidosis can occur along with several types of blood cancers. Experts know cancer cells can sometimes produce amyloid proteins. However, they still don’t know much about the overall disease process or why amyloidosis occurs in some, but not all, people with cancer.

Multiple Myeloma

Multiple myeloma is a blood cancer that is often linked to AL amyloidosis. Multiple myeloma develops from plasma cells, the same cell type that causes AL amyloidosis. Cancerous plasma cells produce high levels of an abnormal immunoglobulin protein, which may be called monoclonal protein, M protein, M spike, or paraprotein. These proteins sometimes form amyloids by attaching to each other or to other proteins.

About 15 percent of people who have multiple myeloma develop AL amyloidosis. Amyloidosis may be more likely to affect certain groups of people. About 2 out of 3 people with AL amyloidosis are male, and most are between the ages of 50 and 80.

People with multiple myeloma should watch out for certain signs and symptoms that can indicate AL amyloidosis. These include:

  • Shortness of breath
  • Diarrhea
  • Feeling full after eating a small amount
  • Weight loss with no clear cause
  • Swelling in the legs, ankles, and feet
  • Peripheral neuropathy (nerve damage that can lead to pain, numbness, or tingling in the hands, arms, feet, or legs)
  • Protein in the urine
  • Enlargement of the liver
  • Heart failure
  • A swollen tongue

People with myeloma may have different sets of symptoms depending on which organs are affected by amyloidosis. In one study of 47 people with both AL amyloidosis and multiple myeloma, 62 percent had amyloid deposits in just one organ. Twenty-three percent of participants had deposits in multiple organs.

Read more about how AL amyloidosis can affect the organs.

If you have multiple myeloma and your doctor suspects you may also have AL amyloidosis, they may recommend you undergo a serum free light-chain assay. This test measures the amount of abnormal light-chain proteins found in your blood. You may also need to get a biopsy (removal of tissue with a needle) of your abdominal fat or bone marrow. Doctors can use the biopsy sample to confirm whether amyloid proteins are present.

Other Blood Cancers

In rare cases, other types of cancerous blood cells can also produce amyloid fibrils.

Non-Hodgkin Lymphoma

Approximately 2 percent to 4 percent of AL amyloidosis cases occur in people with B-cell lymphoma. B-cell lymphoma is a type of non-Hodgkin lymphoma. This cancer develops when lymphocytes (a type of white blood cell) quickly multiply in the lymph nodes, bone marrow, blood, or certain organs.

AL amyloidosis can also develop from Waldenstrӧm’s macroglobulinemia, another type of non-Hodgkin lymphoma. This cancer is a mix between multiple myeloma and B-cell lymphoma — the cells look and act like both plasma cells and B cells. People with AL amyloidosis and non-Hodgkin lymphoma tend to have amyloid deposits in the lymph nodes and in the lungs.

Hodgkin Lymphoma

AL amyloidosis can also occur with Hodgkin lymphoma. Hodgkin lymphoma develops from lymphocytes and leads to the overproduction of large, abnormal cancer cells in the lymphatic system — the organs and vessels that help get rid of waste and fight infections.

Acute Myeloid Leukemia

AL amyloidosis is often a complication of blood cancer. However, blood cancer can also be a complication of amyloidosis. Some people with AL amyloidosis later develop acute myeloid leukemia (AML). This may occur because some amyloidosis treatments can damage cells and eventually lead to AML. Talk to your doctor to learn more about the risks and side effects of different amyloidosis treatment options.

Consequences of AL Amyloidosis and Blood Cancer

Depending on your individual health situation, you may or may not be able to use the same treatments for both amyloidosis and blood cancer. One study of 47 people showed that when people with multiple myeloma were later diagnosed with AL amyloidosis, they switched treatments about 50 percent of the time. In the other half of cases, people continued to use the same treatments to manage both conditions.

However, having two diseases at the same time can sometimes limit treatment options. For example, a stem cell transplant can be used to treat both multiple myeloma and AL amyloidosis. However, if you have amyloid deposits built up in certain organs, you may not be healthy enough to receive this treatment.

People with both multiple myeloma and AL amyloidosis often have a poor prognosis. In the same study of 47 people with multiple myeloma, participants lived for an average of 9.1 months after being diagnosed with AL amyloidosis. This statistic includes data from a small pool of people, and doesn’t necessarily reflect your own prognosis. Some people with both conditions live for a couple of months, while others live for several years after diagnosis. Talk to your health care team if you would like to get a better idea of what to expect.

Certain risk factors affect your prognosis. People with multiple myeloma and AL amyloidosis who have no heart symptoms and those who only have amyloid deposits in one organ are likely to have a better prognosis. Additionally, your prognosis is affected by where in your body amyloid deposits occur. Some people with lymphoma only have amyloid deposition in one small area surrounding the cancer cells. Others have amyloid fibrils spread throughout the body (called systemic amyloidosis). People who have systemic amyloidosis tend to have worse outcomes.

Read about staging and progression in AL amyloidosis.

Talk With Others Who Understand

MyAmyloidosisTeam is the social network for people with amyloidosis and their loved ones. On MyAmyloidosisTeam, members come together to ask questions, give advice, and share their stories with others who understand life with amyloidosis.

Are you living with amyloidosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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