Supportive Care

Another important advance has been the improvements in supportive measures for AL-related organ dysfunction.6 Careful attention to intravascular volume and cardiac function is essential. Many patients with renal involvement require assistance in the form of dialysis, although renal transplants have also been performed in some patients with otherwise good risk disease. Amyloidosis can develop in the graft if the precursor protein is not well controlled. Orthostasis can be treated with elastic stockings, fluorocortisone, and midodrine. Refractory diarrhea has been treated with antidiarrheals, somatostatin analogs, and even diverting colostomies.

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