FRCPath Haem Part 1 MCQs-Oncology 481

A 61-year-old man is diagnosed with systemic primary AL amyloidosis.

Investigations show:

• Bone marrow plasma cells: 8% 

• Serum free light chains: markedly abnormal

• dFLC: 185 mg/L 

• Serum paraprotein: 3 g/L

• NT-proBNP: moderately elevated

• Troponin-T: mildly elevated

• Echocardiogram: increased ventricular wall thickness with preserved ejection fraction

• eGFR: 68 mL/min/1.73 m²

• No significant peripheral neuropathy

• No significant gastrointestinal or respiratory involvement

He is otherwise fit and has no major comorbidities.

Which of the following is the MOST appropriate initial treatment?

A. High-dose melphalan followed immediately by autologous stem-cell transplantation

B. Daratumumab + bortezomib + cyclophosphamide + dexamethasone (Dara-VCD)

C. Lenalidomide + dexamethasone

D. Melphalan + dexamethasone alone

E. Pomalidomide + dexamethasone