nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-196-12-83-93nogr-1803Research ArticleОБЗОРREVIEWСовременные представления о первичном системном AL-амилоидозе: взгляд гастроэнтерологаModern concepts of primary systemic AL-amyloidosis: the viewpoint of a gastroenterologisthttps://orcid.org/0000-0003-3655-9554ГубергрицН. Б.GubergritsN. B.

Губергриц Наталья Борисовна, доктор мед. наук, профессор, президент Украинского клуба панкреатологов

030039, Киев, ул. 40-летия Октября, д. 2665114, Одесса, ул. Академика Королева, 17

Natalia B. Gubergrits, the President of Ukrainian Pancreatic Club, Dr. of Sci. (Med), Professor

030039, Kiev, 40th anniversary of October str, 26   65114, Odessa, Academician Koroleva Street, 17   

profnbg@ukr.netБеляеваН. В.ByelyayevaN. V.

Беляева Надежда Владимировна, кандидат мед. наук, врач-консультант медицинского центра

030039, Киев, ул. 40-летия Октября, д. 2665114, Одесса, ул. Академика Королева, 17

Nadezhda V. Byelyayeva, Cand. of Sci. (Med.), Consultant Doctor 

030039, Kiev, 40th anniversary of October str, 26   65114, Odessa, Academician Koroleva Street, 17   

https://orcid.org/0000-0001-8239-6093МожинаТ. Л.MozhynаT. L.

Можина Татьяна Леонидовна, кандидат мед. наук, врач-консультант

63000 Харьков, ул. Целиноградская, 58-Б

Tetiana L. Mozhyna, Cand. of Sci. (Med.), Consultant Doctor

63000, Kharkov, Tselinogradskaya str, 58-B  

https://orcid.org/0000-0001-5721-6409РахметоваВ. С.RakhmetovaV. S.

Рахметова Венера Саметовна, доктор мед. наук, профессор кафедры внутренних болезней

010000, г. Нур-Султан, ул. Бейбитшилик, 49 а

Venera S. Rakhmetova, Dr. of Sci. (Med), Professor of Department of Internal Diseases

010000, Nur-Sultan city, Beybitshilik str., 49 а

Украинский Клуб панкреатологов; Медицинский центр «Медикап»УкраинаUkrainian pancreatic Club; Medical Centre “Medikap”UkraineЦентр здорового сердца доктора КрахмаловойУкраинаThe Dr. Krakhmalova Center of the Healthy HeartUkraineНАО «Медицинский университет Астана»КазахстанNJSC “Astana medical university”Kazakhstan2021160120220128393Copyright © Губергриц Н.Б., Беляева Н.В., Можина Т.Л., Рахметова В.С., 20222022Губергриц Н.Б., Беляева Н.В., Можина Т.Л., Рахметова В.С.Gubergrits N.B., Byelyayeva N.V., Mozhynа T.L., Rakhmetova V.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1803

Цель обзора—представить анализ современных литературных данных о патогенезе, диагностике и терапии первичного системного амилоидоза легких цепей иммуноглобулинов (AL-амилоидоз), раскрыть особенности гастроэнтерологических проявлений заболевания. AL-амилоидоз обусловлен избыточным синтезом легких цепей иммуноглобулинов клоном плазматических клеток, расположенных в костном мозге, с последующим образованием амилоида.Отложение амилоида в органах мишенях (сердце, почки, печень, желудочно-кишечный тракт, периферическая и автономная нервная системы, мягкие ткани) сопровождается прямым и косвенным цитотоксическим действием на органы и ткани. К гастроинтестинальным проявлениям AL-амилоидоза относят поражение печени, желудочно-кишечные кровотечения, псевдообструкцию тонкого и/или толстого кишечника, появление полиповидных, дивертикуловидных, опухолевидных образований, мальабсорбцию, нарушение моторики желудочно-кишечного тракта, протеин-теряющую гастропатию. Повреждение печени у больных AL-амилоидозом, как правило, сопровождается минимальными клиническими проявлениями, повышением уровня щелочной фосфатазы при условии отсутствия других причин изменения концентрации этого маркера холестаза.Приведен детальный анализ положений практического руководства клиники Мэйо по диагностике, лечению AL-амилоидоза. Диагностика гастроинтестинального AL-амилоидоза основывается на гистомикроскопическом анализе биоптатов пораженных органов с окраской конго красным и последующим осмотром в поляризованном свете; золотым стандартом диагностики заболевания является масс-спектрометрия. Современная фармакотерапия AL-амилоидоза предполагает проведение комбинированной высокодозовой химиотерапии с применением моноклональных антител, ингибиторов протеасом, цитостатиков, гормонов, а также выполнение аутологической трансплантации стволовых клеток. Коррекция гастроэнтерологических проявлений заболевания основана на назначении симптоматических средств. Продолжительность жизни больных AL-амилоидозом определяют посредством нескольких прогностических моделей; шкала Бостонского университета, основанная на определении двух показателей, максимально удобна для применения в практической деятельности.

The purpose of the review is to present an analysis of modern literature data on the pathogenesis, diagnosis and therapy of primary systemic amyloidosis of immunoglobulin light chains (AL-amyloidosis), to reveal the features of gastroenterological manifestations of the disease. AL-amyloidosis is caused by overproduction of immunoglobulin light chains by a clone of plasma cells located in the bone marrow, followed by the formation of amyloid.Deposition of amyloid in target organs (heart, kidneys, liver, gastrointestinal tract, peripheral and autonomic nervous systems, soft tissues) is accompanied by direct and indirect cytotoxic effects on organs and tissues. Gastrointestinal manifestations of AL-amyloidosis include liver damage, gastrointestinal bleeding, pseudo-obstruction of the small intestine and colon, the appearance of polyp-, diverticul-, tumor-like formations, malabsorption, impaired motility of the gastrointestinal tract, protein-losing gastropathy. Liver damage in patients with AL-amyloidosis, as a rule, is accompanied by minimal clinical manifestations, an increase of the level of alkaline phosphatase without any other reasons for this change. A detailed analysis of the Mayo Clinic’s practical guidelines for the diagnosis and treatment of AL-amyloidosis is presented. Diagnosis of gastrointestinal AL-amyloidosis is based on histomicroscopic analysis of biopsies of target organs with Congo red and subsequent examination in polarized light; mass spectrometry is the gold standard of diagnostic. Modern pharmacotherapy of AL-amyloidosis includes a combination of high-dose chemotherapy with monoclonal antibodies, proteasome inhibitors, cytostatics, hormones, as well as performing autologous stem cell transplantation. Correction of gastroenterological manifestations of the disease is based on the symptomatic therapy. Life expectancy of patients with AL-amyloidosis is determined by several prognostic models; the Boston University model, based on the definition of two markers, is most convenient for clinical use.

амилоидAL-амилоидозгастроинтестинальные проявленияamyloidAL-amyloidosisgastrointestinal manifestationsReferencesBenson M.D., Buxbaum J. N., Eisenberg D. S., et al. Amyloid nomenclature 2020: update and recommendations by the International Society of Amyloidosis (ISA) nomenclature committee. Amyloid. 2020;27(4):217–222. doi:10.1080/13506129.2020.1835263.Benson M.D., Buxbaum J. N., Eisenberg D. S., et al. Amyloid nomenclature 2020: update and recommendations by the International Society of Amyloidosis (ISA) nomenclature committee. Amyloid. 2020;27(4):217–222. doi:10.1080/13506129.2020.1835263.D’Aguanno V., Ralli M., Artico M., et al. Systemic Amyloidosis: a Contemporary Overview. Clin Rev Allergy Immunol. 2020;59(3):304–322. doi:10.1007/s12016–019–08759–4.D’Aguanno V., Ralli M., Artico M., et al. Systemic Amyloidosis: a Contemporary Overview. Clin Rev Allergy Immunol. 2020;59(3):304–322. doi:10.1007/s12016–019–08759–4.Ghahghaei A., Faridi N. J. Biomedical Science and Engineering, 2009;2:345–358. doi:10.4236/jbise.2009.25050.Ghahghaei A., Faridi N. J. Biomedical Science and Engineering, 2009;2:345–358. doi:10.4236/jbise.2009.25050.Nuvolone M., Palladini G., Merlini G. Amyloid Diseases at the Molecular Level: General Overview and Focus on AL Amyloidosis. Amyloid and Related Disorders. Current Clinical Pathology. Humana Press, Cham. 2015. doi:10.1007/978–3–319–19294–9_2.Nuvolone M., Palladini G., Merlini G. Amyloid Diseases at the Molecular Level: General Overview and Focus on AL Amyloidosis. Amyloid and Related Disorders. Current Clinical Pathology. Humana Press, Cham. 2015. doi:10.1007/978–3–319–19294–9_2.Karamanos T.K., Kalverda A. P., Thompson G. S., et al. Mechanisms of amyloid formation revealed by solution NMR. Prog Nucl Magn Reson Spectrosc. 2015;88–89:86–104. doi:10.1016/j.pnmrs.2015.05.002Karamanos T.K., Kalverda A. P., Thompson G. S., et al. Mechanisms of amyloid formation revealed by solution NMR. Prog Nucl Magn Reson Spectrosc. 2015;88–89:86–104. doi:10.1016/j.pnmrs.2015.05.002Stroo E., Koopman M., Nollen E. A., et al. Cellular Regulation of Amyloid Formation in Aging and Disease. Front Neurosci. 2017;11:64. doi:10.3389/fnins.2017.00064Stroo E., Koopman M., Nollen E. A., et al. Cellular Regulation of Amyloid Formation in Aging and Disease. Front Neurosci. 2017;11:64. doi:10.3389/fnins.2017.00064Bustamante J. G., Zaidi S. R.H. Amyloidosis. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470285/Bustamante J. G., Zaidi S. R.H. Amyloidosis. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470285/Staron A., Connors L. H., Zheng L., et al. Race/ethnicity in systemic AL amyloidosis: perspectives on disease and outcome disparities. Blood Cancer J. 2020;10(11):118. doi:10.1038/s41408–020–00385–0.Staron A., Connors L. H., Zheng L., et al. Race/ethnicity in systemic AL amyloidosis: perspectives on disease and outcome disparities. Blood Cancer J. 2020;10(11):118. doi:10.1038/s41408–020–00385–0.Amyloidosis: AL (Light Chain). https://my.clevelandclinic.org/health/diseases/15718-amyloidosis-al-amyloidlight-chain.Amyloidosis: AL (Light Chain). https://my.clevelandclinic.org/health/diseases/15718-amyloidosis-al-amyloidlight-chain.Hasib Sidiqi M., Gertz M. A. Immunoglobulin light chain amyloidosis diagnosis and treatment algorithm 2021. Blood Cancer J. 2021;11(5):90. doi:10.1038/s41408–021–00483–7.Hasib Sidiqi M., Gertz M. A. Immunoglobulin light chain amyloidosis diagnosis and treatment algorithm 2021. Blood Cancer J. 2021;11(5):90. doi:10.1038/s41408–021–00483–7.Dittrich T., Kimmich C., Hegenbart U., et al. Prognosis and Staging of AL Amyloidosis. Acta Haematol. 2020;143(4):388–400. doi:10.1159/000508287.Dittrich T., Kimmich C., Hegenbart U., et al. Prognosis and Staging of AL Amyloidosis. Acta Haematol. 2020;143(4):388–400. doi:10.1159/000508287.Rutten K. H.G., Raymakers R. A.P., Minnema M. C. ‘Transformation’ from amyloid light chain amyloidosis to symptomatic multiple myeloma. Neth J Med. 2018;76(5):249–250.Rutten K. H.G., Raymakers R. A.P., Minnema M. C. ‘Transformation’ from amyloid light chain amyloidosis to symptomatic multiple myeloma. Neth J Med. 2018;76(5):249–250.Ghazaleh S., Hindupur A., Nehme C., et al. Gastric amyloidosis in a patient with dysphagia. Gastroenterol Hepatol Bed Bench. 2021;14(2):178–180.Ghazaleh S., Hindupur A., Nehme C., et al. Gastric amyloidosis in a patient with dysphagia. Gastroenterol Hepatol Bed Bench. 2021;14(2):178–180.Merlini G., Dispenzieri A., Sanchorawala V., et al. Systemic immunoglobulin light chain amyloidosis. Nat Rev Dis Primers. 2018;4(1):38. doi:10.1038/s41572–018–0034–3.Merlini G., Dispenzieri A., Sanchorawala V., et al. Systemic immunoglobulin light chain amyloidosis. Nat Rev Dis Primers. 2018;4(1):38. doi:10.1038/s41572–018–0034–3.Muchtar E., Dispenzieri A., Gertz M. A., et al. Treatment of AL Amyloidosis: Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Statement 2020 Update. Mayo Clin Proc. 2021;96(6):1546–1577. doi:10.1016/j.mayocp.2021.03.012.Muchtar E., Dispenzieri A., Gertz M. A., et al. Treatment of AL Amyloidosis: Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Statement 2020 Update. Mayo Clin Proc. 2021;96(6):1546–1577. doi:10.1016/j.mayocp.2021.03.012.Muchtar E., Dispenzieri A., Magen H., et al. Systemic amyloidosis from A (AA) to T (ATTR): a review. J Intern Med. 2021;289(3):268–292. doi:10.1111/joim.13169.Muchtar E., Dispenzieri A., Magen H., et al. Systemic amyloidosis from A (AA) to T (ATTR): a review. J Intern Med. 2021;289(3):268–292. doi:10.1111/joim.13169.Zhang D., Makhni M. C., Kang J. D., et al. Orthopaedic Manifestations of Amyloidosis. J Am Acad Orthop Surg. 2021;29(10): e488-e496. doi:10.5435/JAAOS-D-20–01146.Zhang D., Makhni M. C., Kang J. D., et al. Orthopaedic Manifestations of Amyloidosis. J Am Acad Orthop Surg. 2021;29(10): e488-e496. doi:10.5435/JAAOS-D-20–01146.Dahiya D. S., Kichloo A., Singh J., et al. Gastrointestinal amyloidosis: A focused review. World J Gastrointest Endosc. 2021;13(1):1–12. doi:10.4253/wjge.v13.i1.1.Dahiya D. S., Kichloo A., Singh J., et al. Gastrointestinal amyloidosis: A focused review. World J Gastrointest Endosc. 2021;13(1):1–12. doi:10.4253/wjge.v13.i1.1.Almushait Y. B., Syed F., Abbasi S. U., et a l. Gastroduodenal amyloidosis: a case report and review of literature. J Surg Case Rep. 2021;2021(4): rjab093. doi:10.1093/jscr/rjab093.Almushait Y. B., Syed F., Abbasi S. U., et a l. Gastroduodenal amyloidosis: a case report and review of literature. J Surg Case Rep. 2021;2021(4): rjab093. doi:10.1093/jscr/rjab093.den Braber-Ymker M., Heijker S., Lammens M., et al. Intestinal involvement in amyloidosis is a sequential process. Neurogastroenterol Motil. 2018;30(12): e13469. doi:10.1111/nmo.13469.den Braber-Ymker M., Heijker S., Lammens M., et al. Intestinal involvement in amyloidosis is a sequential process. Neurogastroenterol Motil. 2018;30(12): e13469. doi:10.1111/nmo.13469.Shiratori Y., Fukuda K., Ikeya T., et al. Primary gastrointestinal amyloidosis with gastrointestinal hemorrhage and intestinal pseudo-obstruction: a report of a rare case. Clin J Gastroenterol. 2019;12(3):258–262. doi:10.1007/s12328–018–00929–9.Shiratori Y., Fukuda K., Ikeya T., et al. Primary gastrointestinal amyloidosis with gastrointestinal hemorrhage and intestinal pseudo-obstruction: a report of a rare case. Clin J Gastroenterol. 2019;12(3):258–262. doi:10.1007/s12328–018–00929–9.Tanaka Y., Hosotani K., Fukushima M. A Case of Amyloid Light-Chain Amyloidosis Presenting With Submucosal Hematoma and Bleeding in the Upper Gastrointestinal Tract. Clin Gastroenterol Hepatol. 2020;18(13): e158-e159. doi:10.1016/j.cgh.2019.09.046.Tanaka Y., Hosotani K., Fukushima M. A Case of Amyloid Light-Chain Amyloidosis Presenting With Submucosal Hematoma and Bleeding in the Upper Gastrointestinal Tract. Clin Gastroenterol Hepatol. 2020;18(13): e158-e159. doi:10.1016/j.cgh.2019.09.046.Talar-Wojnarowska R., Jamroziak K. Intestinal amyloidosis: Clinical manifestations and diagnostic challenge. Adv Clin Exp Med. 2021;30(5):563–570. doi:10.17219/acem/133521.Talar-Wojnarowska R., Jamroziak K. Intestinal amyloidosis: Clinical manifestations and diagnostic challenge. Adv Clin Exp Med. 2021;30(5):563–570. doi:10.17219/acem/133521.Gehring S, Stathopoulos P, Denzer UW. Upper Gastrointestinal Bleeding: Hemoclips Do Not Always Solve the Problem. Gastroenterology. 2021;160(7): e12-e13. doi:10.1053/j.gastro.2020.10.052.Gehring S, Stathopoulos P, Denzer UW. Upper Gastrointestinal Bleeding: Hemoclips Do Not Always Solve the Problem. Gastroenterology. 2021;160(7): e12-e13. doi:10.1053/j.gastro.2020.10.052.Kiryukhin A. P., Pavlov P. V., Tertychnyy A. S., et al. Primary systematic AL amyloidosis with upper gastrointestinal involvement: endoscopic findings of a protein deposition disorder. Korean J Intern Med. 2021;36(3):744–745. doi:10.3904/kjim.2020.169.Kiryukhin A. P., Pavlov P. V., Tertychnyy A. S., et al. Primary systematic AL amyloidosis with upper gastrointestinal involvement: endoscopic findings of a protein deposition disorder. Korean J Intern Med. 2021;36(3):744–745. doi:10.3904/kjim.2020.169.Sundaram S., Rathod R. Gastric Amyloidosis Causing Nonvariceal Upper Gastrointestinal Bleeding. ACG Case Rep J. 2019;6(5):3–4. doi:10.14309/crj.0000000000000066.Sundaram S., Rathod R. Gastric Amyloidosis Causing Nonvariceal Upper Gastrointestinal Bleeding. ACG Case Rep J. 2019;6(5):3–4. doi:10.14309/crj.0000000000000066.Lucas Ramos J., Abadía Barno M., Pezzela Risueño Á. Ileal ulcers due to gastrointestinal amyloidosis as an unusual cause of severe lower gastrointestinal bleeding. Rev Esp Enferm Dig. 2019;111(6):493–494. doi:10.17235/reed.2019.5973/2018.Lucas Ramos J., Abadía Barno M., Pezzela Risueño Á. Ileal ulcers due to gastrointestinal amyloidosis as an unusual cause of severe lower gastrointestinal bleeding. Rev Esp Enferm Dig. 2019;111(6):493–494. doi:10.17235/reed.2019.5973/2018.Franck C., Venerito M., Weigt J., et al. Recurrent diffuse gastric bleeding as a leading symptom of gastrointestinal AL amyloidosis. Z Gastroenterol. 2017;55(12):1318–1322. doi:10.1055/s-0043–120924.Franck C., Venerito M., Weigt J., et al. Recurrent diffuse gastric bleeding as a leading symptom of gastrointestinal AL amyloidosis. Z Gastroenterol. 2017;55(12):1318–1322. doi:10.1055/s-0043–120924.Kuroki Y., Kimura K., Harimoto K., et al. A case of primary retroperitoneal amyloidoma resected laparoscopically. Urol Case Rep. 2021;38:101711. doi:10.1016/j.eucr.2021.101711.Kuroki Y., Kimura K., Harimoto K., et al. A case of primary retroperitoneal amyloidoma resected laparoscopically. Urol Case Rep. 2021;38:101711. doi:10.1016/j.eucr.2021.101711.Mohan S., Graziano E., Campbell J., et al. Unusual case of amyloidosis presenting as a jejunal mass. BMJ Case Rep. 2021;14(5): e240226. doi:10.1136/bcr-2020–240226.Mohan S., Graziano E., Campbell J., et al. Unusual case of amyloidosis presenting as a jejunal mass. BMJ Case Rep. 2021;14(5): e240226. doi:10.1136/bcr-2020–240226.Inayat F., Ur Rahman A., Zahid E., et al. Symptomatic involvement of the stomach and duodenum as initial presentation of AL amyloidosis. BMJ Case Rep. 2019;12(1): bcr-2018–227550. doi:10.1136/bcr-2018–227550.Inayat F., Ur Rahman A., Zahid E., et al. Symptomatic involvement of the stomach and duodenum as initial presentation of AL amyloidosis. BMJ Case Rep. 2019;12(1): bcr-2018–227550. doi:10.1136/bcr-2018–227550.Kobayashi T., Yoshikawa S., Takeuchi M., et al. Hepatobiliary and Pancreatic: AL amyloidosis presented as a hematoma in the hepatoduodenal ligament. J Gastroenterol Hepatol. 2019;34(11):1897. doi:10.1111/jgh.14744.Kobayashi T., Yoshikawa S., Takeuchi M., et al. Hepatobiliary and Pancreatic: AL amyloidosis presented as a hematoma in the hepatoduodenal ligament. J Gastroenterol Hepatol. 2019;34(11):1897. doi:10.1111/jgh.14744.Fotiou D., Dimopoulos M. A., Kastritis E. Systemic AL Amyloidosis: Current Approaches to Diagnosis and Management. Hemasphere. 2020;4(4): e454. doi:10.1097/HS9.0000000000000454.Fotiou D., Dimopoulos M. A., Kastritis E. Systemic AL Amyloidosis: Current Approaches to Diagnosis and Management. Hemasphere. 2020;4(4): e454. doi:10.1097/HS9.0000000000000454.Lee B. S., Chudasama Y., Chen A. I., et al. Colonoscopy Leading to the Diagnosis of AL Amyloidosis in the Gastrointestinal Tract Mimicking an Acute Ulcerative Colitis Flare. ACG Case Rep J. 2019;6(11): e00289. doi:10.14309/crj.0000000000000289.Lee B. S., Chudasama Y., Chen A. I., et al. Colonoscopy Leading to the Diagnosis of AL Amyloidosis in the Gastrointestinal Tract Mimicking an Acute Ulcerative Colitis Flare. ACG Case Rep J. 2019;6(11): e00289. doi:10.14309/crj.0000000000000289.Swaminathan R., Igbinedion S., Pandit S. Systemic Immunoglobulin Light Chain Amyloidosis Involving the Large Intestine. ACG Case Rep J. 2021;8(5): e00578. doi:10.14309/crj.0000000000000578.Swaminathan R., Igbinedion S., Pandit S. Systemic Immunoglobulin Light Chain Amyloidosis Involving the Large Intestine. ACG Case Rep J. 2021;8(5): e00578. doi:10.14309/crj.0000000000000578.Al Hamed R., Bazarbachi A. H., Bazarbachi A., et al. Comprehensive Review of AL amyloidosis: some practical recommendations. Blood Cancer J. 2021;11(5):97. doi:10.1038/s41408–021–00486–4.Al Hamed R., Bazarbachi A. H., Bazarbachi A., et al. Comprehensive Review of AL amyloidosis: some practical recommendations. Blood Cancer J. 2021;11(5):97. doi:10.1038/s41408–021–00486–4.Foti R., Leonardi R., Fichera G., Di Gangi M., Leonetti C., Gangemi P., De Pasquale R. Scleredema di Buschke, contributo casistico [Buschke Scleredema, case report]. Reumatismo. 2018;58(4):310–3. Italian. doi:10.4081/reumatismo.2006.310.Foti R., Leonardi R., Fichera G., Di Gangi M., Leonetti C., Gangemi P., De Pasquale R. Scleredema di Buschke, contributo casistico [Buschke Scleredema, case report]. Reumatismo. 2018;58(4):310–3. Italian. doi:10.4081/reumatismo.2006.310.Wu B., Pak D. M., Smith K. D., et al. Utility of Abdominal Skin Punch Biopsy for Detecting Systemic Amyloidosis. J Cutan Pathol. 2021. doi:10.1111/cup.14070.Wu B., Pak D. M., Smith K. D., et al. Utility of Abdominal Skin Punch Biopsy for Detecting Systemic Amyloidosis. J Cutan Pathol. 2021. doi:10.1111/cup.14070.Seo M., Cha H. J., Kim M., et al. Clinical Utility of 18F-Florbetaben PET for Detecting Amyloidosis Associated With Multiple Myeloma: A Prospective Case-Control Study. Clin Nucl Med. 2019;44(9): e503-e509. doi:10.1097/RLU.0000000000002699.Seo M., Cha H. J., Kim M., et al. Clinical Utility of 18F-Florbetaben PET for Detecting Amyloidosis Associated With Multiple Myeloma: A Prospective Case-Control Study. Clin Nucl Med. 2019;44(9): e503-e509. doi:10.1097/RLU.0000000000002699.Hanna M., Ruberg F. L., Maurer M. S., et al. Cardiac Scintigraphy With Technetium-99m-Labeled Bone-Seeking Tracers for Suspected Amyloidosis: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;75(22):2851–2862. doi:10.1016/j.jacc.2020.04.022.Hanna M., Ruberg F. L., Maurer M. S., et al. Cardiac Scintigraphy With Technetium-99m-Labeled Bone-Seeking Tracers for Suspected Amyloidosis: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;75(22):2851–2862. doi:10.1016/j.jacc.2020.04.022.Gavriatopoulou M., Musto P., Caers J., et al. European myeloma network recommendations on diagnosis and management of patients with rare plasma cell dyscrasias. Leukemia. 2018;32(9):1883–1898. doi:10.1038/s41375–018–0209–7.Gavriatopoulou M., Musto P., Caers J., et al. European myeloma network recommendations on diagnosis and management of patients with rare plasma cell dyscrasias. Leukemia. 2018;32(9):1883–1898. doi:10.1038/s41375–018–0209–7.Posadas Martinez M. L., Aguirre M. A., Belziti C., et al. Guía de Práctica Clínica para el diagnóstico de la amiloidosis: Parte 1/3. Año 2020 [Clinical Practice Guidelines for diagnosis of amyloidosis: Part 1/3 Year 2020]. Rev Fac Cien Med Univ Nac Cordoba. 2021;78(1):74–82. Spanish. doi:10.31053/1853.0605.v78.n1.30824.Posadas Martinez M. L., Aguirre M. A., Belziti C., et al. Guía de Práctica Clínica para el diagnóstico de la amiloidosis: Parte 1/3. Año 2020 [Clinical Practice Guidelines for diagnosis of amyloidosis: Part 1/3 Year 2020]. Rev Fac Cien Med Univ Nac Cordoba. 2021;78(1):74–82. Spanish. doi:10.31053/1853.0605.v78.n1.30824.Palladini G., Milani P., Malavasi F., et al. Daratumumab in the Treatment of Light-Chain (AL) Amyloidosis. Cells. 2021;10(3):545. doi:10.3390/cells10030545.Palladini G., Milani P., Malavasi F., et al. Daratumumab in the Treatment of Light-Chain (AL) Amyloidosis. Cells. 2021;10(3):545. doi:10.3390/cells10030545.Palladini G., Milani P., Merlini G. Management of AL amyloidosis in 2020. Hematology Am Soc Hematol Educ Program. 2020;2020(1):363–371. doi:10.1182/hematology.2020006913.Palladini G., Milani P., Merlini G. Management of AL amyloidosis in 2020. Hematology Am Soc Hematol Educ Program. 2020;2020(1):363–371. doi:10.1182/hematology.2020006913.Lysenko (Kozlovskaya) L.V., Rameev V. V., Moiseev S., et al. Clinical guidelines for diagnosis and treatment of systemic amyloidosis. Klinicheskaya farmakologiya i terapiya = Clin Pharmacol Th erapy. 2020;29(1):13–24 (In Russ.) doi:10.32756/0869–5490–2020–1–13–24.Lysenko (Kozlovskaya) L.V., Rameev V. V., Moiseev S., et al. Clinical guidelines for diagnosis and treatment of systemic amyloidosis. Klinicheskaya farmakologiya i terapiya = Clin Pharmacol Th erapy. 2020;29(1):13–24 (In Russ.) doi:10.32756/0869–5490–2020–1–13–24.Лысенко (Козловская) Л.В., Рамеев В. В., Моисеев С. В. и др. Клинические рекомендации по диагностике и лечению системного амилоидоза. Клин фармакол тер 2020;29(1):13–24Лысенко (Козловская) Л.В., Рамеев В. В., Моисеев С. В. и др. Клинические рекомендации по диагностике и лечению системного амилоидоза. Клин фармакол тер 2020;29(1):13–24Zhang K.W., Stockerl-Goldstein K.E., Lenihan D. J. Emerging Therapeutics for the Treatment of Light Chain and Transthyretin Amyloidosis. JACC Basic Transl Sci. 2019;4(3):438–448. doi:10.1016/j.jacbts.2019.02.002.Zhang K.W., Stockerl-Goldstein K.E., Lenihan D. J. Emerging Therapeutics for the Treatment of Light Chain and Transthyretin Amyloidosis. JACC Basic Transl Sci. 2019;4(3):438–448. doi:10.1016/j.jacbts.2019.02.002.Arahata M., Takamatsu H., Morishita E., et al. Coagulation and fibrinolytic features in AL amyloidosis with abnormal bleeding and usefulness of tranexamic acid. Int J Hematol. 2020;111(4):550–558. doi:10.1007/s12185–019–02811-x.Arahata M., Takamatsu H., Morishita E., et al. Coagulation and fibrinolytic features in AL amyloidosis with abnormal bleeding and usefulness of tranexamic acid. Int J Hematol. 2020;111(4):550–558. doi:10.1007/s12185–019–02811-x.Lilleness B., Ruberg F. L., Mussinelli R., Doros G., Sanchorawala V. Development and validation of a survival staging system incorporating BNP in patients with light chain amyloidosis. Blood. 2019 Jan 17;133(3):215–223. doi:10.1182/blood-2018–06–858951.Lilleness B., Ruberg F. L., Mussinelli R., Doros G., Sanchorawala V. Development and validation of a survival staging system incorporating BNP in patients with light chain amyloidosis. Blood. 2019 Jan 17;133(3):215–223. doi:10.1182/blood-2018–06–858951.

The authors declare that there are no conflicts of interest present.