Today, we are outlining the key recommendations made in the American Society of Hematology's (ASH) guideline, 2026 Guidelines on Diagnosis of Light Chain Amyloidosis. To aid clinicians in making timely and accurate diagnoses, ASH developed evidence-based guidelines focused on diagnostic evaluation, assessment of organ involvement, and clinical suspicion enhancement.

Twelve recommendations were developed and are divided into three sections: enhanced clinical suspicion, diagnosis, and organ involvement. Today, we are spotlighting those recommendations in the highlights below, which are divided into their related sections. View the full-text version for the most thorough explanation of the recommendations

Enhanced Clinical Suspicion
  • In individuals where cardiac amyloidosis is suspected, the guideline recommends using serum free light chain assay together with serum and urine immunofixation to help detect AL amyloidosis. 
  • In individuals presenting with unexplained proteinuria, the guideline suggests paraprotein tests, including serum and urine immunofixation and serum free light chain testing, to evaluate for possible AL amyloidosis. 
  • In individuals with positive serum or urine immunofixation or serum free light chain assay, along with abnormal cardiac biomarkers, and echocardiography is not diagnostic, the guideline suggests using cardiac magnetic resonance to further evaluate for possible cardiac amyloidosis. 
  • In individuals with positive serum or urine immunofixation or serum free light chain assay, along with abnormal cardiac biomarkers, and echocardiography findings are consistent with amyloidosis, the guideline suggests against cardiac magnetic resonance and to proceed directly to tissue biopsy to confirm diagnosis for cardiac AL amyloidosis. 
Diagnosis
  • In individuals with suspected AL amyloidosis, the guideline recommends against using bone scintigraphy for AL cardiac amyloidosis diagnosis. 
  • In individuals who are suspected of having cardiac amyloidosis and without evidence of a plasma cell disorder, the guideline recommends bone scintigraphy to diagnose Cardiac ATTR amyloidosis. 
  • In individuals with positive serum or urine immunofixation or serum free light chain assay, along with abnormal cardiac biomarkers, and diagnostic echocardiography, who have suspected AL cardiac amyloidosis, the guideline suggests either starting with both bone marrow biopsy and fat pad sampling or with endomyocardial biopsy. 
  • In individuals with positive serum or urine immunofixation, or serum free light chain assay, the guideline suggests starting with  both bone marrow biopsy and fat pad sampling over renal biopsy. 
  • In individuals with autonomic neuropathy and a monoclonal gammopathy and large or generalized small fiber peripheral neuropathy and suspected AL amyloidosis, the guideline suggests both bone marrow biopsy and fat pad sampling over nerve biopsy. 
  • In individuals with possible multiorgan AL amyloidosis, the guideline suggests starting with both bone marrow biopsy and fat pad sampling over target organ biopsy. 
  • In individuals with multiple myeloma and smoldering myeloma, or plasma cell dyscrasias, the guideline suggests Congo red staining on biopsies of bone marrow that may have already been obtained. 
Organ Involvement
  • In individuals with confirmed AL amyloidosis who do not have cardiac symptoms, the guideline recommends checking cardiac biomarkers along with cardiac imaging over not obtaining these tests to evaluate for cardiac involvement at diagnosis. 

Sign up for alerts and stay informed on the latest published guidelines and articles.

Copyright © 2026 Guideline Central, all rights reserved.