During the coronavirus 2019 (COVID-19) pandemic, management of incidence of light chain (AL) amyloidosis and immunoglobulin deposition disease (IDD) must be individualized depending on biological aspects of the disease, clinical characteristics, the clinical center’s access to care under the pandemic, and the epidemiological aspects of the outbreak in certain regions, according to a study published in the European Journal of Haematology.
Since the beginning of the COVID-19 pandemic, a major concern has been to assess which patient populations are the most vulnerable and who is at the highest risk for severe COVID-19. Although several investigations have suggested that patients with cancer, specifically hematologic cancers, may develop more severe COVID-19 and have higher fatality rates, patients with other hematologic disorders may also be at a greater risk.
“Despite the smaller clonal burden [compared with symptomatic multiple myeloma], AL amyloidosis and IDD are associated with risks of infections secondary to the plasma cell disorder itself, and the combination of chemo- and immunotherapies used for treatment are associated with immune compromise,” the authors wrote.
To determine how the COVID-19 pandemic has affected the management of AL amyloidosis and IDD, a team of researchers from the Tom Baker Cancer Center and Charbonneau Cancer Research Institute, both in Calgary, Alberta, Canada, collected data from patients seen at their institution from 2013 to 2020 who were registered in the local Plasma Cell Disorders Database.
A total of 96 patients were registered in the database. During the pandemic, 22 patients with systemic AL amyloidosis and 4 patients with IDD received treatment. Of the cohort, 15 patients had localized amyloidosis (median age, 69 years), 74 patients had systemic AL amyloidosis (median age, 66 years), and 7 patients had IDD (median age, 66 years).
Compared with patients with IDD, patients with AL amyloidosis were more likely to have lambda restrictions (15% vs 73%, P =.01). Patients with IDD had higher serum creatinine and bone marrow plasma cell levels, and half of the cases of light chain IDD were associated with symptomatic multiple myeloma; however, these differences were not statistically significant.
Of the 15 patients with localized amyloidosis, none of the patients progressed or needed systemic therapy at the time of the study.
Since the pandemic, if patients achieved very good partial response or better, treatment was discontinued; 7 patients discontinued treatment after achieving very good partial response. In addition, of the 28 patients who were tested for COVID-19, all tested negative. During the course of the study, 3 patients died: 2 patients died from organ complications due to systemic AL amyloidosis and the other patient died from unrelated cause.
“These patients’ cases represent the risk of delays in prompt diagnosis of AL amyloidosis during the pandemic where clinical follow up is limited by virtual medicine,” the investigators noted.
“Equally important in the care of AL amyloidosis and IDD patients is to address patients’ emotional burdens that can be associated with feelings of vulnerability to illness and isolation that accompanies social distancing measures. All patients should be informed and engaged in the discussion of their individual infection risks and referred for allied health and community supports when possible,” concluded the researchers.
Lee H, Tay J, Duggan P, et al. The impact of COVID-19 in the management of AL amyloidosis and immunoglobulin deposition disease: a single center experience. Eur J Haematol. Published online November 16, 2020. doi:10.1111/ejh.13552