Tele-consultation in the management of systemic light chain (AL) amyloidosis: the Pavia amyloidosis centre experience

AUTORI

ABSTRACT

Introduction: light chain (AL) amyloidosis complexity requires specialized laboratories and use of highly sensitive methods for disease monitoring. During COVID-19 outbreak, access to our diagnostic facility was limited and a telemedicine (TM) program was established to maintain patients’ management.
Methods: patients were asked to perform specific blood and urine tests at a local laboratory. Biopsy samples were shipped to Pavia for amyloid typing.
Results: in 2020, 369 TM were performed. For 102 (27%) patients, this was the first contact with our center, 73 (71%) of them received a final diagnosis and the specific therapeutic treatment, whereas in 29 (28%) the diagnostic suspicion was not confirmed. A TM was done in 276 (72%) patients previously evaluated, 214 (80%) of them had systemic AL with 99 (46%) receiving chemotherapy [89 (41%) proceeded with therapy, 10 (4%) suspended due to sustained hematologic response]. Seven (3%) started a new treatment due to loss of hematologic response. In all other cases, hematologic response was confirmed, and treatment free interval was prolonged. In 2021, 109 patients previously evaluated in our Center performed TM, of them 54 (50%) had a systemic AL. In 11 (19%) patients ongoing chemotherapy was proceeded and in one case a new therapy was suggested due to disease progression.
Discussion: through this TM based-approach we reached a final diagnosis in 71% of cases and we assessed hematologic and organ response in local laboratories making clinical decisions. Despite being a response to pandemic, this hub and spoke TM model proved effective in a complex disease.

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