
Yashori Chathurma Piyarathna
Colombo South Teaching Hospital, Sri LankaPresentation Title:
Amyloid Light-Chain (AL) amyloidosis in a middle-aged lady: Confronting the challenges of a rare diagnosis in a developing country
Abstract
Background:
Light-chain (AL) Amyloidosis is an uncommon disease in individuals under 40 years, with renal amyloidosis in this age group typically attributed to chronic inflammatory conditions. Early diagnosis and access to targeted therapy are essential to prevent irreversible organ damage, yet such management remains a significant challenge in low-resource settings.
Case Presentation:
We report the case of a 37- year-old female presenting with sub nephrotic- range proteinuria, constitutional symptoms, tender hepatomegaly, and cervical lymphadenopathy. Serum protein electrophoresis identified a monoclonal band (17 g/L). Bone marrow biopsy showed 20% pleomorphic plasma cells, and serum free light chain assay indicated an abnormal kappa/lambda ratio of 0.11 with elevated lambda light chains (126.21 mg/L). Congo red-positive amyloid deposits in renal and lymph node biopsies confirmed AL amyloidosis. She was classified as Mayo Clinic Stage I disease. The patient received nine cycles of CycloBorDex (Cyclophosphamide, Bortezomib, Dexamethasone), achieving a very good partial hematologic and organ response, followed by autologous stem cell transplantation. However, disease progression was observed six months post-transplant, with increasing difference in free light chain and proteinuria. Due to financial constraints, salvage therapy was planned with VRD (Bortezomib, Lenalidomide, Dexamethasone) rather than Daratumumab.
Conclusion: This case highlights the importance of early recognition and biopsy-confirmed diagnosis of AL amyloidosis, even in younger patients. It also underscores a pressing global health issue: limited access to optimal therapies in resource-constrained environments. Ensuring equitable access to advanced treatment modalities remains a key challenge in managing complex hematologic disorders like AL amyloidosis in low- and middle-income countries.
Biography
Chathurma Piyarathna is a Senior Registrar in Clinical Haematology at Colombo South Teaching Hospital, Kalubowila, Sri Lanka. She obtained her MBBS from the University of Sri Jayewardenepura in 2013 and completed both the Diploma and MD in Clinical Haematology from the Postgraduate Institute of Medicine, University of Colombo in 2024. With over a decade of clinical experience, She has served in various capacities, including emergency medicine and specialist hematology units. Her clinical interests lie in plasma cell dyscrasias, particularly light-chain (AL) Amyloidosis, multiple myeloma, and hematologic malignancies. She is passionate about early diagnosis, multidisciplinary care, and equitable access to advanced therapies, especially in low-resource settings. Dr. Piyarathna has contributed to case-based research and quality improvement projects within Sri Lanka’s public healthcare system. She is committed to advancing haematology care through both clinical service and academic engagement. Her recent work highlights the diagnostic and therapeutic challenges of managing AL amyloidosis in younger patients, emphasizing the need for awareness and resource-sensitive treatment strategies in developing countries. She is currently involved in ongoing clinical care and research while advocating for improved access to novel agents for haematologic diseases in resource-limited environments