To the Editor:
We would like to discuss the article “COVID-19 and Light Chain Amyloidosis (AL), Adding Insult to Injury,”
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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…”- Crees ZD
- Stockerl-Goldstein K
COVID-19 and light chain amyloidosis, adding insult to injury [Online ahead of print].
Am J Med. 2022 Jan 23; https://doi.org/10.1016/j.amjmed.2022.01.005
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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.- Crees ZD
- Stockerl-Goldstein K
COVID-19 and light chain amyloidosis, adding insult to injury [Online ahead of print].
Am J Med. 2022 Jan 23; https://doi.org/10.1016/j.amjmed.2022.01.005
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.
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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.References
- COVID-19 and light chain amyloidosis, adding insult to injury [Online ahead of print].Am J Med. 2022 Jan 23; https://doi.org/10.1016/j.amjmed.2022.01.005
- COVID-19 vaccination in oncology patients receiving chemotherapy.Clin Oncol (R Coll Radiol). 2021; 33: e467
- Plasma cell myeloma, hyperviscosity and amyloidosis associated with a serum IgG3 lambda and urinary excretion of two fragments related to the variable portion of lambda light chains.Clin Immunol Immunopathol. 1981; 19: 55-66
- Expected viscosity after COVID-19 vaccination, hyperviscosity and previous COVID-19.Clin Appl Thromb Hemost. 2021; 2710760296211020833
- Blood viscosity of COVID-19 patient: a preliminary report.Am J Blood Res. 2021; 11: 93-95
Article Info
Footnotes
Funding: None.
Conflicts of Interest: None.
Authorship: Both authors contributed equally – Substantial contributions to study conception and design, acquisition of data, analysis and interpretation of data; Drafting the article or revising it critically for important intellectual content; and Final approval of the version of the article to be published.
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