In amyloid light-chain amyloidosis (AL amyloidosis), also known as primary amyloidosis or immunoglobulin light-chain amyloidosis, plasma cells in your bone marrow produce abnormal immunoglobulin light chains, which result in misfolded proteins known as amyloid building up in tissues and organs.

The goals of treatment for AL amyloidosis are to reduce the production of amyloid proteins, keep organs functioning normally, and improve quality of life. Since AL amyloidosis progresses rapidly without treatment, doctors recommend the quickest and most effective treatments that can be tolerated.

Here, we’ll cover different treatment options for AL amyloidosis, including combination treatments, chemotherapy, and other drugs.

The Importance of Early Diagnosis and Treatment

Diagnosing amyloidosis can take some time, but a proper diagnosis is vital before treatment can begin. Early detection and diagnosis can help you start treatment as quickly as possible.

Before recommending a treatment plan, your doctor will evaluate your overall health and check whether amyloidosis may be impacting your heart and kidneys. These details will help your doctor determine whether your case of amyloidosis is high or low risk and decide which treatments to recommend.

There is currently no cure for AL amyloidosis, but establishing your treatment plan can rapidly stop abnormal plasma cells from producing amyloid proteins and help stabilize damaged organs.

Medication Options To Treat AL Amyloidosis

Medications can stop or slow the progression of AL amyloidosis. However, they cannot remove the amyloid deposits already in the body. Therefore, the goal of medication for AL amyloidosis is to prevent more amyloid deposits from forming.

Combination Treatments

Most people who have AL amyloidosis take a combination of medications. A combination of treatments is called a treatment regimen. The current standard first-line regimen includes an anti-CD38 monoclonal antibody, a proteasome inhibitor, cyclophosphamide, and dexamethasone.

So far, the only first-line treatment regimen approved by the U.S. Food and Drug Administration (FDA) for AL amyloidosis is a combination of daratumumab, cyclophosphamide, bortezomib, and dexamethasone, also called D-CVd or DaraCyborD. Other drug combinations may also be used if DaraCyborD isn’t the most fitting option.

Chemotherapy

Chemotherapy drugs destroy abnormal cells in the bone marrow. Sometimes a doctor may recommend combining a chemotherapy drug with stem cell transplantation. The chemotherapy drugs used to treat AL amyloidosis include:

• Cyclophosphamide, often a part of first-line treatment
• Melphalan

In addition to traditional chemotherapy drugs, your doctor may recommend immunomodulatory drugs like lenalidomide or pomalidomide. These drugs are not FDA-approved for AL amyloidosis specifically. However, they are FDA-approved for multiple myeloma, which often underlies AL amyloidosis.

Corticosteroids

Corticosteroid medications, such as dexamethasone, are often used alongside chemotherapy drugs or other drugs as part of a first-line treatment.

Proteasome Inhibitors

Some doctors may also recommend proteasome inhibitors as part of AL amyloidosis treatment. Proteasomes are protein structures within cells that are responsible for cleaning up damaged and abnormal proteins.

Proteasome inhibitors are drugs that stop proteasomes from working normally. This prevents plasma cells from breaking down unwanted or misfolded proteins. Eventually, the abnormal plasma cells react to this change by dying, thereby reducing the production of amyloidogenic light chains.

The proteasome inhibitor bortezomib is often a part of first-line treatment for AL amyloidosis. Other proteasome inhibitors sometimes used to treat AL amyloidosis are carfilzomib and ixazomib.

Immunotherapy

Immunotherapy is a type of treatment that uses parts of your immune system to fight cancer and other diseases. Monoclonal antibodies are one type of immunotherapy that can be used to treat AL amyloidosis. Monoclonal antibodies are immune proteins that have been bioengineered to recognize and neutralize a specific molecule.

The most common immunotherapy drug used for AL amyloidosis is daratumumab. In 2025, the FDA-approved daratumumab/hyaluronidase-fihj (Darzalex Faspro) in combination with bortezomib, cyclophosphamide, and dexamethasone as a standard treatment for newly diagnosed AL amyloidosis.

New Drugs in Clinical Trials

New treatments for amyloidosis are being studied in clinical trials. One potential drug under investigation for treatment of AL amyloidosis involves an amyloid-fibril-targeting monoclonal antibody therapy called anselamimab (CAEL-101), which progressed to phase 3 clinical trials for advanced cardiac AL amyloidosis.

For people who are eligible to participate, clinical trials for amyloidosis can provide access to new therapies that are not yet widely available.

Stem Cell Transplant

Stem cell transplants, formerly known as bone marrow transplants, may help prevent the production of amyloid proteins. Stem cell transplants are considered highly effective treatments for AL amyloidosis in certain people who are eligible to receive them.

Organ Transplant

Organ transplants can replace a diseased and damaged organ with a healthy one from a donor. For people with AL amyloidosis, both kidney transplantation and heart transplantation have had good clinical outcomes. However, transplants aren’t appropriate for all people with organ-involved AL amyloidosis, particularly if the amyloid deposits are found in several organs.

Lifestyle Changes and AL Amyloidosis

Lifestyle changes may help with some of the symptoms of AL amyloidosis. Ask your doctor how you can safely include exercise in your routine while considering how AL amyloidosis affects your heart, causes fatigue, or affects your health in other ways. They can also help you make healthy changes to your diet.

If you’re experiencing poor appetite and unintentional weight loss with AL amyloidosis, you may find that going on a short walk can stimulate appetite. Regular exercise can also help fight fatigue and pain. However, keep in mind that a healthy lifestyle isn’t a substitute for sticking with the treatment plan tailored for your condition in close partnership with your doctor.