Table 4. Supportive therapy in AL... | American Society of Hematology

Table 4.

Supportive therapy in AL amyloidosis

Condition	Supportive measures
Fluid retention	• Salt restriction • Careful administration of diuretics (furosemide or torasemide, spironolactone) Liberal use can worsen hypotension and reduce pre-load which can exacerbate cardiac dysfunction
Hypotension	• Fitted elastic stockings • Midodrine, droxidopa, and pyridostigmine
Neuropathy	• Gabapentin and pregabalin • Serotonin-norepinephrine reuptake inhibitors (duloxetine and venlafaxine)
Diarrhea	• Loperamide • Octreotide in patients who are refractory to loperamide
Malnutrition	• Nutritional counseling and support
End-stage renal disease	• Dialysis • Renal transplant in eligible patients with adequate hematologic response (CR/VGPR)¹⁰¹
Heart failure	• Beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers should be used with great caution in cardiac amyloidosis • Heart transplant in eligible young patients with severe heart damage and with minimal or no extracardiac involvement. This should be followed by effective chemotherapy. Risk-adapted chemotherapy while on transplant list is recommended under intensive monitoring

Condition	Supportive measures
Fluid retention	• Salt restriction • Careful administration of diuretics (furosemide or torasemide, spironolactone) Liberal use can worsen hypotension and reduce pre-load which can exacerbate cardiac dysfunction
Hypotension	• Fitted elastic stockings • Midodrine, droxidopa, and pyridostigmine
Neuropathy	• Gabapentin and pregabalin • Serotonin-norepinephrine reuptake inhibitors (duloxetine and venlafaxine)
Diarrhea	• Loperamide • Octreotide in patients who are refractory to loperamide
Malnutrition	• Nutritional counseling and support
End-stage renal disease	• Dialysis • Renal transplant in eligible patients with adequate hematologic response (CR/VGPR)¹⁰¹
Heart failure	• Beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers should be used with great caution in cardiac amyloidosis • Heart transplant in eligible young patients with severe heart damage and with minimal or no extracardiac involvement. This should be followed by effective chemotherapy. Risk-adapted chemotherapy while on transplant list is recommended under intensive monitoring

See Cibeira et all.⁷⁰