A Multidisciplinary Team Approach for Diagnosis and Treatment of Patients with AL Amyloidosis

AL amyloidosis is a plasma cell dyscrasia. It is a rare and fatal progressive disease in which abnormal proteins misfold, form fibrils and deposit in one or more vital organs causing permanent tissue damage and failure. Timely diagnosis is are crucial to improve the patient’s ability to tolerate more aggressive and effective therapies, thus increasing their chance of disease control and improved survival.  New drugs and treatment regimens are now available in addition to high dose melphalan and stem cell transplantation (HDM/SCT).  However, disease complexity and factors involved in determining a patient’s best treatment options remain a challenge. Utilizing a multidisciplinary team approach is critical in enhancing communication between the referring physicians, the clinical team members and the patient regarding the extent of disease and the treatment plan. Clinical pathways and standard operating procedures are followed throughout disease evaluation and treatment. Medical records and pathology specimens are reviewed prior to the scheduled appointments in the Multidisciplinary Amyloid Clinic to establish the accurate pathologic subtyping of each amyloid precursor protein and determine the evaluation plan.  Each new patient typically meets with an Amyloid Internist, Hematologist, Cardiologist, Nephrologist and other specialists as indicated based on the patient’s organ involvement and co-morbidities. If a clinical trial or HDM/SCT is included among the treatment options, a Research Nurse and/or Transplant Nurse Practitioner meets with the patient and family to provide a program overview and protocol specifics.  Weekly meetings involving different professionals specialized in the amyloid diseases, including Hematologists, Internists, Pathologists, Cardiologists, Nephrologists, Pulmonologists, Psychiatrists, Nutritionists, Clinical Research Staff, Insurance Coordinators and Nurse Practitioners are essential to individualized patient care.  During weekly patient conferences, team members provide input regarding clinical assessments and test results obtained during the two-day comprehensive disease evaluation.  At these meetings, individual patient cases are discussed in detail, treatment options reviewed and clinical trial eligibility determined.  Following the multidisciplinary review, the Amyloid Team discusses with each patient the recommendations, the involved risks and benefits of the different treatment options and the next steps to be taken. In addition, all results and recommendations are discussed with the referring physician.  A multidisciplinary team approach allows for a timely, efficient and effective method to determine and administer safe care to patients, especially in a rare and complex multi-system disease such as AL amyloidosis.