Plasma cell disorders
AL amyloidosis (light-chain amyloidosis)
Also called Immunoglobulin-related amyloidosis (AL amyloidosis)
If you or someone you love has just heard this diagnosis, start here. This guide explains what the condition is, how it is usually treated and where a transplant fits.
AL amyloidosis occurs when an abnormal cell clone produces antibody light chains that misfold and damage organs. Treatment suppresses that clone; some carefully selected patients receive high-dose chemotherapy followed by their own stem cells.
Other names and abbreviations
AL amyloidosis, light-chain amyloidosis, amyloidosis, Primary systemic light-chain amyloidosis, amyloid light-chain amyloidosis
In short
- AL amyloidosis happens when abnormal cells make antibody pieces called light chains. These pieces fold the wrong way and damage organs such as the heart and kidneys.
- Treatment aims to stop those abnormal cells, often with a mix of medicines. Its strength is adjusted to how well the heart and other organs are working.
- Some carefully chosen patients get high-dose chemotherapy followed by their own stem cells. Because the cells are their own, an unrelated donor is not part of usual care.
Jump to a section
Underlined words open a short explanation. See all terms
Where transplant fits
Selected patients with sufficient organ function receive autologous stem cell rescueComing from the patient's own body. In an autologous transplant, the patient's own stem cells are collected and stored, then given back after high-dose treatment. It does not use a donor. after high-dose chemotherapyVery strong drug treatment given in large doses, often to kill cancer cells. It also destroys the bone marrow and can cause other serious side effects. A stem cell transplant usually follows to rebuild the marrow.. This uses their own cells; an unrelated donor is not part of routine AL amyloidosis care.
Treatment depends on the exact diagnosis, disease stage, prior treatment and the person’s health.
Key facts
- Who it affects
- Systemic AL amyloidosis mainly affects adults, usually in later adulthood.
- How common
- About 1.2 new cases per 100,000 people a year; median age at diagnosis 7635 residents of Olmsted County, Minnesota, U.S., diagnosed 1990–2015 (rate adjusted for age and sex to the 2010 U.S. population) Source: How common
- Cells used in a transplant
- The patient’s own collected blood-forming cells for autologous stem cell rescue, when that procedure is appropriate.
- Where a donor fits
- Usually the person’s own cells
The condition
What it is
“AL” means amyloid light chain. The light chains are produced by an abnormal plasma-cell clone, or less often a B-cellA type of white blood cell that makes antibodies. B cells are part of the immune system and grow from stem cells in the bone marrow. Some lymphomas and leukemias start in B cells. clone, and can form amyloid deposits in tissues. The clone may be small even when organ damage is serious.
AL is one type of amyloidosis, and this page covers only AL. Another type, transthyretin (ATTR) amyloidosis, is being found more and more often. It comes with age or runs in families, and its deposits most often affect the heart. ATTR that affects the heart is treated with different medicines, such as tafamidis, rather than chemotherapy and a stem cell transplantA treatment that gives a patient healthy blood-forming stem cells through a vein. The cells travel to the bone marrow and replace faulty marrow or marrow damaged by treatment. They can come from the patient or a donor.. That is why doctors test the amyloid to find its exact type. Finding an abnormal antibodyA protein made by the immune system that sticks to one specific target, such as a germ. Some wrongly target the body's own tissues. Lab-made antibody medicines can target markers such as CD20 or CD38 on some cancer cells. protein in the blood does not by itself prove that the amyloid is AL.
Marked as affected: plasma cells.
- Blood stem cell, In the bone marrow
- Myeloid line
- Red blood cells
- Platelets
- Granulocytes
- Monocytes
- Lymphoid line
- B cells
- Plasma cells, Affected, Develop from B cells
- T cells
- NK cells, Natural killer cells
- Myeloid line
What causes it
The disease involves an acquired antibody-producing clone and light chains with a tendency to misfold. The reason it develops in an individual is usually unknown.
AL amyloidosis itself is not the usual inherited form of amyloidosis and is not contagious. However, distinguishing it from other amyloid types requires tissue and laboratory assessment rather than assuming that every amyloid diagnosis has the same cause.
Symptoms and effects
Deposits and light-chain toxicity can affect the heart, kidneys, nerves, liver, gut and soft tissues. Symptoms may include breathlessness, swelling, fatigue, dizziness on standing, numbness or digestive problems.
Heart involvement is especially important in assessing risk and treatment tolerance. Kidney protein loss and other organ effects may also need treatment. The amount of abnormal marrowThe soft, spongy tissue in the center of most bones. Red bone marrow holds the blood-forming stem cells that make red blood cells, white blood cells and platelets. plasma cells does not reliably describe the severity of organ disease.
A simple drawing of a body. Can be affected: mouth and teeth, heart, liver, kidneys, stomach and bowel, skin and nerves.
Can be affected
- Mouth and teeth: a swollen tongue
- Heart
- Liver
- Kidneys
- Stomach and bowel
- Skin
- Nerves: numbness in the hands or feet
This shows the parts of the body the condition can affect. Most people have only some of these, and the drawing says nothing about how severe any of them will be.
Diagnosis and treatment
How AL amyloidosis is diagnosed
AL amyloidosis can be hard to spot. Its early signs, such as tiredness, swelling, shortness of breath or protein in the urine, look like many common problems. Because of this, diagnosis is often late. By the time it is found, more than 2 in 3 people already have more than one organ affected.
The first step is usually blood and urine tests for an abnormal antibody protein. These include a free light chain test and immunofixation, which shows the exact protein type. To prove amyloid is there, a small tissue sample is stained with a dye called Congo red. A needle sample of belly fat, a bone marrow biopsy or a salivary gland sample is often enough. Only about 15% of people need a biopsy of the heart, kidney or another organ.
Next, the lab confirms that the amyloid is made of light chains. The most exact test is mass spectrometry. This step matters because other types, such as transthyretin (ATTR) amyloidosis, are treated very differently. Heart blood tests (NT-proBNP or BNP, and troponin), a heart ultrasound (echocardiogram) or heart MRI show how much the heart is involved.
A positive tissue stain shows that amyloid is present, but not which type it is. Typing the amyloid is a separate step.
How it is treated
Treatment targets the light-chain-producing clone, often with daratumumab and a bortezomib-based combination. The intensity must be adjusted to organ involvement and medical condition, especially severe cardiac disease.
Selected patients can receive high-dose melphalan with autologous stem cell rescue. Eligibility is stricter than for many other blood disorders because fragile heart, blood-pressure or organ function can make high-dose treatment dangerous. Response to initial drug therapy also affects whether and when transplantation is useful.
Supportive treatment for affected organs is essential. A fall in abnormal light chains is a hematologic response; organ improvement may take longer and may be incomplete. Stem cell rescue does not directly remove all existing amyloid deposits.
Kinds of treatment described for AL amyloidosis (light-chain amyloidosis): supportive care, medicines and a transplant with the person’s own cells (for some people).
After diagnosis, the options described here
Supportive care
Supportive treatment for affected organs, such as the heart and kidneys, is essential.
Medicines
Medicines target the cells that make the light chains, often daratumumab with a bortezomib-based mix.
Transplant with the person’s own cells, For some people
Some carefully chosen people have high-dose chemotherapy followed by their own stem cells.
What a transplant involves
These are the kinds of treatment this page describes, not a plan. Which ones fit, in what order and whether they are combined differs from person to person.
When transplant specialists are usually consulted
NMDP and ASTCT guidelines recommend a transplant consultation at diagnosis, and again if AL amyloidosis progresses or comes back. Whether a transplant with the person’s own cells fits depends on heart, blood pressure and kidney function, and on how well the first medicines work.
Read the guidanceWhat a transplant involves
- Step 1
: Collecting the person’s own cells
Medicines move stem cells out of the marrow and into the blood. The cells are then collected and frozen.
- Step 2
: High-dose treatment
The person receives strong treatment, usually high-dose chemotherapy.
- Step 3
: Cells returned, Day 0
The stored cells are thawed and given back through a vein, like a transfusion.
- Step 4
: Blood counts recover
The returned cells settle in the marrow and start making blood cells again.
- Step 5
: Follow-up
The care team keeps checking recovery and watches for infection and for the condition coming back.
Daily life and the donor’s role
Living with the condition and treatment
Care often involves several specialties. Fluid balance, blood pressure, kidney function, nutrition and nerve symptoms may need attention alongside the blood disorder. Ordinary advice for an otherwise healthy person may not fit someone with cardiac amyloidosis.
People may feel better at a different pace than their laboratory results improve. Transplant assessment should explain why a person is or is not eligible and how drug treatment and organ support will continue if transplant is unsuitable.
The role of a blood stem cell donor
The usual stem cell transplant used for AL amyloidosis is autologous and uses the patient’s own cells. It supports recovery after chemotherapy directed at the abnormal clone.
An unrelated registry donor is not part of this usual treatment, and allogeneic transplantationComing from another person. In an allogeneic, or donor, transplant, the stem cells come from a relative or an unrelated volunteer whose cells are a close enough match to the patient's. is not routine AL treatment. Registry volunteers help the many other patients who need donated stem cells; most people with AL amyloidosis are not waiting for a donor.
Highlighted here: the person’s own cells.
The person’s own cells
Autologous transplant, no donor
Collected from the person before treatment, then given back.
A relative
Donor transplant (allogeneic)
A brother or sister may be a full match. Parents and children can be half-matched donors.
An unrelated volunteer
Donor transplant (allogeneic)
Found through a donor registry.
Donated cord blood
Donor transplant (allogeneic)
Collected from a baby’s umbilical cord after birth and stored in a public bank.
Looking ahead
Looking ahead
Outlook for AL amyloidosis
Outlook depends most on the heart. Doctors set the stage with two heart blood tests and the level of abnormal free light chains. People with little heart involvement usually do much better than people with advanced heart disease at diagnosis. The first months are the hardest time. At one large U.S. center, about 1 in 4 people diagnosed in 2010 to 2014 died within 6 months.
Outcomes have improved, helped by earlier diagnosis and better medicines. Treatment aims for a deep drop in the abnormal light chains. For a minority of carefully chosen people, high-dose chemotherapy followed by their own stem cellsYoung cells that can grow into every type of blood cell: red cells that carry oxygen, white cells that fight infection and platelets that help blood clot. They are found in the bone marrow and the bloodstream. can bring deep, lasting responses.
About these numbers. Each one says which group of people it comes from, and the place and years where the source gives them. It describes what happened across that group, not what will happen to any one person. And a figure measured among people who had a transplant is not the same as the number of people who need one.
- 56 months (about 4.7 years)Median survival after diagnosis
846 people newly diagnosed with AL amyloidosis in Sweden, 2011–2019, national population-based registers
Read the source: Median survival after diagnosis - 77%Alive 5 years after a transplant with their own stem cells
800 people with AL amyloidosis who had an autologous transplant in 2007–2012 at North American centers reporting to the CIBMTR
Read the source: Alive 5 years after a transplant with their own stem cells
The transplant figure describes people chosen because they were fit enough for high-dose treatment. It does not describe everyone with AL amyloidosis, and no figure can predict how one person will do.
Common questions
Is AL amyloidosis a type of cancer?
Not exactly. AL amyloidosis is caused by a small group of abnormal plasma cells in the bone marrow, the same kind of cell involved in myeloma. But NMDP notes that it is not considered a cancer (malignancy), and experts describe the abnormal cells as slow-growing. The harm comes from the light chains these cells make. The light chains fold the wrong way and build up in organs. It is often treated with medicines also used for myeloma.
What is the life expectancy with AL amyloidosis?
It varies widely, mostly with how much the heart is affected at diagnosis. People with little heart involvement who respond well to treatment often live many years. People with advanced heart involvement face more risk, especially in the first months. Outcomes have improved with newer medicines. The outlook section on this page gives the figures, with the groups they describe. No group figure can predict how one person will do.
What are the first symptoms of AL amyloidosis?
Symptoms depend on which organs are affected, and they often look like common problems. They can include tiredness, shortness of breath, swelling in the arms or legs, weight loss, numbness in the hands or feet, and a drop in blood pressure when standing up. Some people notice a swollen tongue, skin changes, carpal tunnel syndrome or diarrhea. Kidney involvement can cause protein loss in the urine. Because the signs are so varied, diagnosis is often delayed.
Is AL amyloidosis hereditary?
Not usually. AL amyloidosis comes from abnormal plasma cells that develop during life, and the reason it starts is usually unknown. Some other types differ. Transthyretin (ATTR) amyloidosis can come with age, or from an inherited gene change passed down in families. Because each type is treated very differently, the amyloid in a tissue sample is tested to find its exact type, most precisely by mass spectrometry. An abnormal antibody protein in the blood does not by itself prove the amyloid is AL.
Can people with AL amyloidosis have a stem cell transplant?
Some can. The transplant uses the person’s own stem cells, collected first and returned after high-dose chemotherapy. Only a minority qualify, about 1 in 5 in a 2020 review, because the heart, blood pressure and kidneys must be strong enough. European guidance says people without severe heart failure may benefit. Survival after transplant has improved over time. The outlook section on this page gives the figure. A transplant may also be offered when the first medicines do not bring a deep enough response.
Is AL amyloidosis the same as multiple myeloma?
No, but they are related. Both start from abnormal plasma cells. In myeloma, the cancer cells build up in the bone marrow, weaken bones and crowd out healthy blood cells. In AL amyloidosis, the group of abnormal cells is often small, and the harm comes from misfolded light chains that collect in organs such as the heart and kidneys. Myeloma can cause amyloidosis, so the two can occur together. Many of the same medicines treat both, and the National Cancer Institute covers AL amyloidosis in its summary on plasma cell neoplasms.
For your next appointment
AL amyloidosis (light-chain amyloidosis)
From the Jada Bascom Foundation disease library, jadabascomfoundation.org. Printed .
Questions to bring to your care team
- Has the amyloid been typed, for example by mass spectrometry, to confirm it is AL and not ATTR or another type?
- Which organs are involved, and what stage do my heart blood tests (NT-proBNP and troponin) and light-chain levels put me in?
- Could I have a transplant with my own stem cells now, later if the first medicines are not enough, or not at all? Why?
- How deep a light-chain response are we aiming for, and when might my heart or kidneys start to improve?
- What is the exact name of the diagnosis or subtype, and what does it mean for treatment?
- What is the goal of each treatment you are suggesting?
- How does a transplant compare with the other treatments on offer?
- Where can our family find support during treatment?
A one-page list to take to the next appointment, with room for notes.
Supporting someone with a diagnosisSupport for patients and families
These independent organizations offer information and support. JBF is not affiliated with them.
- Amyloidosis Foundation US nonprofit offering up-to-date information, webinars and help by phone, email or mail for people with amyloidosis, including AL amyloidosis.United States
- Amyloidosis Research Consortium (ARC) Nonprofit sharing patient booklets, webinars, peer support and a treatment center finder for people with amyloidosis, including AL amyloidosis.United States
- Myeloma UK UK charity with an AL amyloidosis guide, an Infoline, a peer buddy service, a discussion forum and AL amyloidosis support groups.United Kingdom
Sources and further reading
- Systemic Light Chain Amyloidosis
EBMT Handbook / NCBI Bookshelf, Accessed 2026-09-05 - Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ), Health Professional Version
NCI, Accessed 2026-09-05 - Indications for haematopoietic cell transplantation and CAR-T: 2025 EBMT practice recommendations
EBMT / Bone Marrow Transplantation, Accessed 2026-09-05 - Stem Cell and Bone Marrow Transplants for Cancer
NCI, Accessed 2026-09-05 - Comprehensive Review of AL amyloidosis: some practical recommendations
Blood Cancer Journal (Al Hamed R, et al.), 2021-05-18; accessed 2026-09-26 - Immunoglobulin Light Chain Amyloidosis: 2026 Update on Diagnosis, Prognosis, and Treatment (abstract)
American Journal of Hematology (Gertz MA), 2026-02-22; accessed 2026-09-26 - Immunoglobulin light chain amyloidosis: 2018 Update on diagnosis, prognosis, and treatment (abstract)
American Journal of Hematology (Gertz MA), 2018; accessed 2026-09-26 - Immunoglobulin light chain amyloidosis: 2020 update on diagnosis, prognosis, and treatment (abstract)
American Journal of Hematology (Gertz MA), 2020; accessed 2026-09-26 - Primary amyloidosis
MedlinePlus (U.S. National Library of Medicine), Reviewed 2025-01-01; accessed 2026-09-26 - Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ), Patient Version
National Cancer Institute, Updated 2023-11-17; accessed 2026-09-26 - Plasma cell disorders: HCT consultation guidelines and outcomes (NMDP/ASTCT Recommended Timing for Transplant Consultation)
NMDP, Accessed 2026-09-26 - Incidence of AL Amyloidosis in Olmsted County, Minnesota, 1990 through 2015
Mayo Clinic Proceedings (Kyle RA, et al.; PMC6401262), 2019; accessed 2026-09-26 - Epidemiology and clinical outcomes of light-chain amyloidosis in Sweden: A nationwide population-based study (abstract)
European Journal of Haematology, 2023; accessed 2026-09-26 - Improved Outcomes After Autologous Hematopoietic Cell Transplantation for Light Chain Amyloidosis: A Center for International Blood and Marrow Transplant Research Study
Journal of Clinical Oncology (D’Souza A, et al.; CIBMTR; PMC4737858), 2015; accessed 2026-09-26 - Improved outcomes for newly diagnosed AL amyloidosis between 2000 and 2014: cracking the glass ceiling of early death
Blood (Muchtar E, et al.; PMC5391625), 2017; accessed 2026-09-26
This information explains a condition and its treatments. It cannot diagnose an illness or recommend treatment for an individual. Your care team can explain how the evidence applies to you. Written and source-checked by the Jada Bascom Foundation. Each page lists the published sources it draws on.
Ways to help
Other patients need a donor.
A transplant for AL amyloidosis (light-chain amyloidosis) usually uses the patient’s own cells, but thousands of other patients need a donor. For many of them, that donor is a stranger who joined a registry.
Join the registry
JBF points you to the official registry that serves your country. It explains who can join and what donation involves.
Support this work
Gifts to the Jada Bascom Foundation support donor-awareness education like this page, community outreach, drive planning and referrals to official registries.
Help a family find a donor
Our family guide explains practical ways to help someone who needs a donor. A registration drive can add many potential donors at once, for them and for others.
More in the library
Keep learning
Part of 2 diagnosis guides, each explaining how its subtypes fit together: Myeloma and related plasma cell disorders and Types of blood cancer.
