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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Hematology

Is AL Amyloidosis a Type of Cancer or Multiple Myeloma?

At a Glance

AL amyloidosis is a clonal plasma-cell disorder on the blood-cancer spectrum, but it is not the same as multiple myeloma. Its abnormal cells usually produce light chains that form organ-damaging amyloid deposits; some patients have both conditions.

AL (immunoglobulin light-chain) amyloidosis is classified as a clonal plasma-cell disorder or neoplasm, meaning it sits on the blood-cancer spectrum [1]. It is not the exact same disease as multiple myeloma, though they are closely related [2]. Both conditions originate in the bone marrow from abnormal plasma cells—white blood cells that normally make antibodies to fight infection [2]. However, they behave differently in the body and cause different types of damage.

How They Differ

In multiple myeloma, a larger population of abnormal plasma cells multiplies in the bone marrow [3]. This widespread marrow disease acts like a traditional blood cancer, potentially causing weakened areas of bone (bone lesions), high blood calcium levels, significant anemia, and kidney damage [3].

In AL amyloidosis, the abnormal plasma cell population is often small—commonly making up less than 10% of the cells in a bone marrow biopsy (a sample of your blood-forming tissue) [4]. The primary danger is not from the cells crowding the marrow, but from what they produce [5]. These cells act like a broken factory, producing abnormal pieces of antibodies called light chains [5]. These light chains misfold into structures called amyloid fibrils and deposit in tissues—most commonly the heart, kidneys, nerves, liver, or gastrointestinal tract [6][3]. Over time, these deposits can impair organ function or lead to organ failure if left untreated [7].

Comparing AL Amyloidosis and Multiple Myeloma

Feature AL Amyloidosis Multiple Myeloma
Origin Abnormal plasma cells in the bone marrow [2] Abnormal plasma cells in the bone marrow [2]
Abnormal Clone Size Usually small (often less than 10%) [4] Usually larger and actively multiplying [3]
Main Cause of Harm Light chains forming amyloid deposits in organs [5] Widespread marrow crowding, bone damage, and kidney injury [3]
Can They Coexist? Yes, about 10% to 20% of cases overlap [8] Yes [8]

Why You Are Seeing a Hematologist or Oncologist

It is common to feel anxious when referred to a cancer specialist for a disease you may not recognize as cancer. You are seeing a hematologist (blood specialist) or oncologist (cancer specialist) because they are the experts in treating bone marrow and plasma-cell disorders [9].

To treat AL amyloidosis, doctors must stop the “broken factory” from making amyloid-forming light chains [10]. They do this using plasma-cell-directed therapies [9]. While often broadly referred to as “chemotherapy,” these treatments usually include targeted drugs like proteasome inhibitors (such as bortezomib) or monoclonal antibodies (such as daratumumab) [11][12].

The immediate goal of treatment is to rapidly reduce or suppress the abnormal plasma cells and stop new light-chain production [13]. By turning off the factory, doctors can prevent further amyloid buildup, giving your organs a chance to gradually improve over months or years [13]. However, because existing deposits can be slow to clear, organ recovery can sometimes be incomplete, requiring ongoing supportive care [14].

Can You Have Both?

Because both diseases involve abnormal plasma cells, about 10% to 20% of patients newly diagnosed with AL amyloidosis also meet the clinical criteria for multiple myeloma [8][15]. Doctors determine this by evaluating your bone marrow and checking for myeloma-defining features like bone lesions, significant anemia, or severe kidney injury [3][16]. A plasma-cell clone alone does not automatically mean you have multiple myeloma. If you do have both, your care team will tailor your regimen to treat both the bone marrow disease and the organ involvement [9].

Common questions in this guide

Is AL amyloidosis considered a type of cancer?
AL amyloidosis is classified as a clonal plasma-cell disorder, or blood-related neoplasm, so it is on the blood-cancer spectrum. It is not the same disease as multiple myeloma, although both begin with abnormal plasma cells and can occur together.
How is AL amyloidosis different from multiple myeloma?
Multiple myeloma usually involves a larger group of abnormal plasma cells that can crowd the bone marrow and cause bone lesions, high calcium, anemia, or kidney damage. In AL amyloidosis, the abnormal cell group is often smaller, but it produces light chains that misfold and deposit in organs.
Can a person have AL amyloidosis and multiple myeloma at the same time?
Yes. About 10% to 20% of people newly diagnosed with AL amyloidosis also meet clinical criteria for multiple myeloma. Doctors look at the bone marrow and check for findings such as bone lesions, significant anemia, high calcium, or severe kidney injury; a plasma-cell clone alone does not establish multiple myeloma.
Why would someone with AL amyloidosis see a hematologist or oncologist?
Hematologists and oncologists specialize in disorders involving the blood, bone marrow, and plasma cells. They use plasma-cell-directed treatment to reduce the abnormal cells and stop production of the light chains that form amyloid deposits.
What treatments are used for AL amyloidosis?
Treatment may include plasma-cell-directed medicines such as the proteasome inhibitor bortezomib or the monoclonal antibody daratumumab, along with supportive care for affected organs. The goal is to stop new light-chain production; organ recovery may take months or years and can be incomplete.
How do doctors check whether AL amyloidosis and myeloma overlap?
Doctors review the percentage of abnormal plasma cells in a bone marrow biopsy and look for multiple-myeloma-defining findings, including bone lesions, significant anemia, high calcium, or severe kidney injury. These results help determine whether the person has AL amyloidosis alone or both conditions.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Do my test results show any multiple-myeloma-defining features, such as bone lesions, significant anemia, or high calcium?
  2. 2.What percentage of abnormal plasma cells was found in my bone marrow biopsy, and how does this affect my diagnosis?
  3. 3.Which of my organs are currently affected by amyloid deposits?
  4. 4.What are the benefits, main risks, and alternatives of the specific plasma-cell-directed therapy you are recommending for me?
  5. 5.How frequently will we check my blood and urine to monitor if the treatment is successfully stopping light-chain production?
  6. 6.When might we expect to see signs of organ recovery, and how will that be measured compared to my blood response?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

What Is Life Expectancy in AL Amyloidosis With Treatment?Am I Eligible for a Stem Cell Transplant for AL Amyloidosis?How Can I Manage Scanxiety During AL Amyloidosis Testing?What Side Effects Can I Expect with Dara-CyBorD Treatment?Does AL Amyloidosis Require Salt or Fluid Restrictions?Why Do I Get Dizzy Standing Up With AL Amyloidosis?How Does Kidney Function Affect AL Staging and NT-proBNP?How to Find an AL Amyloidosis Specialist and CenterIs AL Amyloidosis Genetic or Hereditary? ExplainedWhy Does AL Amyloidosis Cause Raccoon Eyes (Purpura)?What Causes AL Amyloidosis? Is It Lifestyle-Related?What Does dFLC Mean in AL Amyloidosis Blood Tests?Why Am I Still Sick After AL Amyloidosis Treatment?

References

References (16)
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    Plasma cell neoplasms and related entities-evolution in diagnosis and classification.

    Fend F, Dogan A, Cook JR

    Virchows Archiv : an international journal of pathology 2023; (482(1)):163-177 doi:10.1007/s00428-022-03431-3.

    PMID: 36414803
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    Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology.

    Kumar SK, Callander NS, Alsina M, et al.

    Journal of the National Comprehensive Cancer Network : JNCCN 2017; (15(2)):230-269 doi:10.6004/jnccn.2017.0023.

    PMID: 28188192
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    The Challenges in Chemotherapy and Stem Cell Transplantation for Light-Chain Amyloidosis.

    Muchtar E, Lin G, Grogan M

    The Canadian journal of cardiology 2020; (36(3)):384-395 doi:10.1016/j.cjca.2019.11.032.

    PMID: 32145866
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    Immunoglobulin light chain amyloidosis: 2018 Update on diagnosis, prognosis, and treatment.

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    American journal of hematology 2018; (93(9)):1169-1180 doi:10.1002/ajh.25149.

    PMID: 30040145
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    Light chain amyloidosis: Where are the light chains from and how they play their pathogenic role?

    Zhang C, Huang X, Li J

    Blood reviews 2017; (31(4)):261-270 doi:10.1016/j.blre.2017.03.002.

    PMID: 28336182
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    Systemic Amyloidosis Due to Clonal Plasma Cell Diseases.

    Bianchi G, Kumar S

    Hematology/oncology clinics of North America 2020; (34(6)):1009-1026 doi:10.1016/j.hoc.2020.08.001.

    PMID: 33099420
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    Immunoglobulin light chain amyloidosis: 2024 update on diagnosis, prognosis, and treatment.

    Gertz MA

    American journal of hematology 2024; (99(2)):309-324 doi:10.1002/ajh.27177.

    PMID: 38095141
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    AL Amyloidosis and Multiple Myeloma: A Complex Scenario in Which Cardiac Involvement Remains the Key Prognostic Factor.

    Ríos-Tamayo R, Krsnik I, Gómez-Bueno M, et al.

    Life (Basel, Switzerland) 2023; (13(7)) doi:10.3390/life13071518.

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    Treatment of AL Amyloidosis: Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Statement 2020 Update.

    Muchtar E, Dispenzieri A, Gertz MA, et al.

    Mayo Clinic proceedings 2021; (96(6)):1546-1577 doi:10.1016/j.mayocp.2021.03.012.

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    Recent advances in the management of AL Amyloidosis.

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    British journal of haematology 2016; (172(2)):170-86 doi:10.1111/bjh.13805.

    PMID: 26491974
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    Daratumumab plus CyBorD for patients with newly diagnosed light chain (AL) amyloidosis.

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    Therapeutic advances in hematology 2021; (12()):20406207211058334 doi:10.1177/20406207211058334.

    PMID: 34840708
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    Treatment Options For Relapsed/refractory Systemic Light-Chain (AL) Amyloidosis: Current Perspectives.

    Sarosiek S, Sanchorawala V

    Journal of blood medicine 2019; (10()):373-380 doi:10.2147/JBM.S183857.

    PMID: 31695543
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    Minimal residual disease negativity by next-generation flow cytometry is associated with improved organ response in AL amyloidosis.

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    Blood cancer journal 2021; (11(2)):34 doi:10.1038/s41408-021-00428-0.

    PMID: 33594045
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    Beyond the plasma cell: emerging therapies for immunoglobulin light chain amyloidosis.

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    The Evolving Landscape of Anti-Clonal Therapy in Newly Diagnosed Systemic Light-Chain (AL) Amyloidosis: Evidence- and Time-Based Comparison with Multiple Myeloma.

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    Progressive Macroglossia and Dysphagia as the Initial Manifestation of Systemic Amyloid Light-Chain (AL) Amyloidosis Associated With Multiple Myeloma: A Case Report and Literature Review.

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    Cureus 2026; (18(5)):e108908 doi:10.7759/cureus.108908.

    PMID: 42299191

This page is for informational purposes only and does not constitute medical advice. Your hematologist or oncologist can interpret your test results and explain how AL amyloidosis relates to multiple myeloma in your case.

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