COVID-19 and Light Chain Amyloidosis: Correspondence

To the Editor:

We would like to discuss the article “COVID-19 and Light Chain Amyloidosis (AL), Adding Insult to Injury,”¹ published in a recent issue of The American Journal of Medicine. Crees and Stockerl-Goldstein mentioned that “… overlap creates unique challenges in caring for patients with AL which are further compounded by the immunosuppressive nature of anti-plasma cell therapies, the need for frequent clinical assessments and the exclusion of AL patients from initial COVID-19 vaccine trials…”¹ We agree that managing COVID-19 and administering COVID-19 immunization to patients with underlying disease can be difficult. The immunodeficiency aspect of AL, as well as the need to use immunosuppressive drugs, is frequently a problem in COVID and vaccine management. A fundamental concern is if there is a danger associated with management or vaccination.

Treatment is essential if there is an infection, regardless of whether or not the patient has previously used immunomodulatory drugs. Similarly, during a pandemic, everybody must practice illness prevention. The clinical issue is usually about the drug/vaccine's efficacy and safety. Because of the compromised immune nature of the AL disease, reduced medication and vaccination efficacy is likely. If there is excellent pre-vaccine planning and post-vaccination monitoring, vaccination should be no difficulty. The quick increase in blood viscosity following immunization, similar to that of a cancer patient on chemotherapy, may pose a safety risk.² Because the AL patient may have a background high blood viscosity,³ and increased blood viscosity is a biological process after COVID-19 vaccination⁴ or COVID-19 infection,⁵ monitoring the AL patient's background thrombohemostatic status during therapy or immunization may be necessary.