Challenges in the Management of patients with systemic light chain (AL) amyloidosis during the COVID‐19 pandemic

Kastritis, Efstathios; Wechalekar, Ashutosh; Schönland, Stefan; Sanchorawala, Vaishali; Merlini, Giampaolo; Palladini, Giovanni; Minnema, Monique; Roussel, Murielle; Jaccard, Arnaud; Hegenbart, Ute; Kumar, Shaji; Cibeira, Maria Teresa; Blade, Joan; Dimopoulos, Meletios A.

The SARS‐CoV‐2‐associated disease (COVID‐19) is primarily manifested as a respiratory tract infection but may affect and cause complications from multiple organ systems (cardiovascular, gastrointestinal, kidneys, hematopoietic and immune systems) while no proven specific therapy exists. The challenges associated with COVID‐19 are even greater for patients with light chain (AL) amyloidosis, a rare multisystemic disease affecting the heart, kidneys, liver, gastrointestinal and nervous system. Patients with AL amyloidosis may need to receive chemotherapy, which probably increases infection risk. Management of COVID‐19 may be particularly challenging in patients with AL amyloidosis who often present with cardiac dysfunction, nephrotic syndrome, neuropathy, low blood pressure and gastrointestinal symptoms. In addition, AL patients may be more susceptible to toxicities of drugs used to manage COVID‐19. Access to health care may be difficult or limited, diagnosis of AL amyloidosis may be delayed with detrimental consequences, treatment administration may need modification. Both patients and treating physicians need to adapt in a new reality.