Pomalidomide With Melphalan and Dexamethasone for Untreated Systemic AL Amyloidosis

Inclusion criteria

• ✓. Age \>/= 18 years old.
• ✓. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2; Karnofsky \>/= 60%
• ✓. Patients must be willing and able to provide voluntary written informed consent, with the understanding that consent may be withdrawn by the subject at any time without prejudice to their future medical care
• ✓. Histologic diagnosis of amyloidosis by Congo red staining of tissue biopsy within 12 months of enrollment.
• ✓. Demonstrable clonal plasma cell disorder based on the presence of an M protein in the serum and/or urine by immunofixation and/or serum free light chain assay, and/or a clonal population of plasma cells in the bone marrow based on kappa/lambda staining of a marrow biopsy.
• ✓. If no demonstrable associated light chain abnormality, then no-light chain amyloidosis should be excluded by checking for transthyretin, fibrinogen A alpha, Amyloid A\^3.
• ✓. Patients must have measurable disease, as defined by at least one of the following: Serum or urine immunofixation showing a monoclonal protein and clonal marrow plasmacytosis by marrow biopsy immunohistochemical staining; Free light chains with an abnormal free light chain ratio
• ✓. Symptomatic end organ involvement with amyloidosis as defined previously and to include any one of the following: Renal - albuminuria higher than 0.5 g/day in 24-hour urine analysis; Cardiac - presence of a mean left ventricular wall thickness on echocardiogram more than 11 mm in the absence of a history of hypertension or valvular heart disease, or unexplained low voltage (\<0.5 mV) on electrocardiogram; Hepatic - hepatomegaly on physical examination with an alkaline phosphatase level higher than 200 U/L; Gastrointestinal - gastrointestinal amyloid deposits confirmed by tissue biopsy.; Soft-tissue or lymphatic involvement - ascertained based on classic physical exam findings (macroglossia, shoulder pad sign, raccoon eyes, carpal tunnel syndrome, synovial enlargement, firm enlarged lymph nodes) or biopsy.