The Basics

Written by the doctors and editors at UpToDate

What is AL amyloidosis?

This is a type of amyloidosis, which is the buildup of abnormal proteins (called "amyloid") in the body. These proteins build up in different organs, which can lead to problems.

There are different types of amyloidosis, depending on which protein is abnormal. This type involves a type of protein called "light chains." In AL amyloidosis, the "A" is for amyloidosis and the "L" is for light chains. It is also called "immunoglobulin light chain amyloidosis." Normal light chains are used to make antibodies, which help the body fight infections. In AL amyloidosis, cells in the bone marrow (the tissue inside bones that makes blood cells) make abnormal light chains. These abnormal light chains can build up in the kidneys, heart, liver, and other organs.

AL amyloidosis mostly affects older adults. It is more common in males than in females.

Sometimes, AL amyloidosis is related to another problem, such as:

● Multiple myeloma – This is a cancer of a type of white blood cell called "plasma cells."

● Waldenström macroglobulinemia – This is a rare type of lymphoma, which is cancer of the lymphatic system.

Not everyone with AL amyloidosis has one of these other problems. Your doctor will do tests to check for them.

What are the symptoms of AL amyloidosis?

Different people get different symptoms. They might include:

● Feeling very tired

● Losing weight without trying

● Swelling in the feet, ankles, legs, or belly

● Shortness of breath

● Numbness or tingling in the hands or feet

● A large tongue

● Skin that bruises easily

● Purple or bruised-looking skin around the eyes

● Bleeding more than usual, for example, after an injury

AL amyloidosis can affect just 1 organ or multiple. Commonly affected organs include the:

● Kidneys – Kidney problems can lead to too much protein in the urine. They can also cause fluid to build up in the body, which leads to swelling. The kidneys might not work as well as they should, which can lead to kidney failure (when they stop working completely).

● Heart – The heart might have trouble pumping blood normally. This can lead to symptoms of heart failure, such as swelling or trouble breathing. Some people also have an abnormal heartbeat.

● Liver – The liver might be larger than normal.

Is there a test for AL amyloidosis?

Yes. If you have symptoms of AL amyloidosis, your doctor or nurse will do an exam and tests. Some tests look for the abnormal protein people with AL amyloidosis have. Other tests check for problems with your organs.

Tests include:

● Urine tests

● Blood tests

● Biopsy – The doctor takes a small sample of tissue and then looks at the sample under a microscope for problems. Your doctor might do a biopsy of your bone marrow as well as a biopsy from your belly area. They might also do a biopsy from a different organ.

● Imaging tests – These create pictures of the inside of the body. Your doctor might suggest imaging tests to look at your internal organs. For example, you might get an echocardiogram (or "echo") to check your heart or an ultrasound to check your liver.

Your doctor might suggest other tests, too, depending on your symptoms. This might seem like a lot of tests. But it's important for your doctor to know for sure if you have amyloidosis and which type. That's because AL amyloidosis is treated differently from other types.

How is AL amyloidosis treated?

There is no cure. But treatment can help reduce symptoms, and help you live longer. Treatment options include chemotherapy and antibodies. Some people might also need a bone marrow transplant. But this is not an option for everybody.

Before starting treatment, you will need to get more tests. These help your doctor see which of your organs are affected, and how much damage there is. They can also check for other problems that might need treatment.

Treatment might include:

● Chemotherapy – This is a group of medicines that kill cancer cells or stop them from growing. They can also stop growth of the cells that make the abnormal protein in AL amyloidosis.

● Antibodies – These are proteins in the blood. The immune system makes them to help the body fight infections. But there are other types of antibodies that are created in a lab and used as medicine. They kill the cells that make the abnormal protein in AL amyloidosis.

● Bone marrow transplant (also called a "stem cell transplant") – This procedure replaces the abnormal cells in your bone marrow with healthy cells. To treat AL amyloidosis, the "donor cells" come from your own body. Stem cells are removed from your blood, then you get chemotherapy to kill the abnormal cells in your bone marrow. After that, your stem cells are returned to your body through a vein. The new stem cells help replace the cells that were destroyed by chemotherapy and grow into healthy bone marrow.

Your doctor or nurse might also talk with you about being in a clinical trial. This is a research study that uses volunteers to test new treatments.

After treatment, your doctor will do regular tests to see if the amount of abnormal protein in your body has gone down. They will also do tests to check if the problems with your organs have gotten better. If not, your doctor might suggest trying a different medicine or combination of medicines.

What else should I do?

Follow all your doctor's instructions about visits and tests. It's also important to talk to your doctor about any side effects or problems you have during treatment.

Getting treated for AL amyloidosis involves making many choices, such as which treatment to have and when. Always tell your doctors and nurses how you feel about a treatment. Any time you are offered a treatment, ask:

● What are the benefits of this treatment? Is it likely to help me live longer? Will it reduce or prevent symptoms?

● What are the downsides of this treatment?

● Are there other options besides this treatment?

● What happens if I do not have this treatment?

All topics are updated as new evidence becomes available and our peer review process is complete.

This topic retrieved from UpToDate on: Apr 17, 2026.

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