The heterogeneity of clinical features and outcome in AL amyloidosis have inspired attempts to identify key determinants of prognosis in these patients. Presence of congestive heart failure and the total number of organs/systems involved are predictive of adverse outcome in several studies.25 However, these features are quite subjective and may depend on the extent of evaluation of organ involvement. More recent studies have begun to test more objective criteria based on laboratory tests that have predictive value in other plasma cell diseases. These studies have identified serum level of p-2 microglobulin and markers of cardiac involvement (brain natriuretic peptide and troponins) as dominant predictors of outcome.27'28'36 37 Assessment of prognostic factors is likely to assume major importance in the therapy of AL, as patient selection has a major effect on the outcome with some newer approaches (such as high-dose chemotherapy). Ongoing research will help clarify the impact of light chain variable region (VL) usage and other features of the amyloido-genic protein as predictors of outcome in AL.38
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