Which specialist treats amyloidosis?

Amyloidosis Treatment Requires a Multidisciplinary Team of Specialists

Amyloidosis requires treatment by a multidisciplinary team of specialists coordinated by a hematologist, who serves as the primary specialist for managing this complex condition. 1, 2

Core Specialist Team for Amyloidosis Management

• Hematologist: Serves as the primary specialist for AL amyloidosis, directing anti-plasma cell therapies and coordinating overall care 1, 2
• Cardiologist: Essential for managing cardiac involvement, which is present in most cases and is the main driver of mortality 1, 2
• Nephrologist: Manages kidney involvement, proteinuria, and renal dysfunction that frequently occur in amyloidosis 1, 2
• Gastroenterologist: Addresses GI tract involvement, malabsorption, and other digestive complications 1

Specialist Involvement Based on Organ System Affected

• Neurologist: Required when peripheral or autonomic nervous system involvement is present 1, 3
• Transplant specialists: Needed for evaluation of stem cell transplantation in AL amyloidosis or organ transplantation in advanced cases 1, 2
• Palliative care specialists: Important for symptom management and quality of life optimization 1, 2

Collaborative Care Model

The American College of Cardiology emphasizes that effective management of amyloidosis requires close collaboration between specialists due to the multisystem nature of the disease 1:

• Hematologists and cardiologists collaborate for:

  • Interpretation of abnormal monoclonal protein screens 1
  • Monitoring for cardiotoxicity of AL amyloidosis therapies 1
  • Assessment for stem cell transplantation eligibility 1, 2
  • Evaluation for heart transplantation candidacy 1, 2

• Gastroenterologists become involved when:

  • Symptoms don't respond to dietary adjustments or over-the-counter medications 1
  • Significant malnutrition or unexplained weight loss occurs 1
  • Endoscopy/colonoscopy is needed for biopsies 1
  • Complications like malabsorption or GI bleeding develop 1

• Nephrologists contribute through:

  • Managing nephrotic syndrome and chronic kidney disease 1, 2
  • Interpreting serum free light chain concentrations in kidney impairment 1, 2
  • Addressing kidney effects of anti-plasma cell therapies 1, 2
  • Preparing for kidney replacement therapy when needed 1, 2

Common Pitfalls in Specialist Care

• Delayed diagnosis: Amyloidosis is often diagnosed late due to nonspecific symptoms; early specialist referral is critical 1, 4
• Inadequate typing: Failure to differentiate between AL and ATTR amyloidosis can lead to inappropriate treatment 2, 3
• Fragmented care: Without coordination between specialists, treatment may be suboptimal 1, 2
• Overlooking cardiac involvement: Even when other organs are primarily affected, cardiac evaluation is essential as heart involvement drives prognosis 1, 2

Treatment Approach

The treatment strategy depends on amyloidosis type but always requires specialist coordination:

• AL amyloidosis: Hematologist-directed treatment targeting the plasma cell clone with:

  • Daratumumab-CyBorD as first-line therapy for most patients 1, 2, 5
  • High-dose melphalan with stem cell transplantation for eligible patients 1, 2
  • Careful monitoring for treatment toxicities by cardiologists 1

• ATTR amyloidosis: Requires different specialist approach with:

  • Cardiologist-directed treatment for cardiac manifestations 1, 3
  • Neurologist involvement for neuropathic symptoms 1, 3
  • Targeted therapies specific to ATTR amyloidosis 2, 3

The multidisciplinary approach to amyloidosis is essential for optimal outcomes, with the hematologist typically serving as the lead coordinator of care while involving other specialists based on organ involvement patterns 1, 2.