Amyloidosis Presents Earlier in India Than in Western Countries, Systematic Review Finds

Amyloidosis is a complex condition involving the systemic deposition of insoluble protein fibrils across various tissues, yet there remains a critical dearth of comprehensive clinical data specific to the Indian subcontinent; therefore, Dr. Sumeet Mirgh from the Department of Hematology and Dr. Uday Yanamandra, along with their colleagues, conducted the systematic review to synthesize existing clinical knowledge and pinpoint specific research gaps that continue to hinder optimal patient care.

Therefore, the comprehensive systematic review utilized the PubMed database to analyze English-language literature and international conference abstracts spanning a significant duration from 1959 to 2023, specifically evaluating study populations, diagnostic methodologies, and patient outcomes to identify trends in systemic and localized disease. The researchers focused on primary endpoints related to the prevalence of different amyloid types and the clinical presentation of the disease, ensuring a broad overview of the Indian medical landscape by extracting data on demographics and diagnostic strategies while excluding non-English publications.

Key Clinical Findings of the Study Include:

• Younger Demographic Profile: The review demonstrates that Indian patients typically present at a median age of 50 years, which is notably ten years younger than the average age of 60 years observed in Western populations.

• Dominance of Renal Involvement: Data indicate that the kidneys are the primary site of organ involvement, with secondary (AA) amyloidosis occurring more frequently than light-chain (AL) amyloidosis, often as a secondary complication of chronic infections like tuberculosis.

• Prevalent Cardiac Complications: In the review, cardiac involvement serves as the second most frequent clinical manifestation, impacting a significant proportion of approximately 40% to 50% of the patient population.

• Localized Skin Manifestations: In cases where the disease remains localized rather than systemic, the skin represents the most frequent site of involvement, accounting for 68% of all such reported cases.

• Underutilized Therapeutic Options: The analysis reveals that although chemotherapy remains the primary treatment for light-chain amyloidosis, resource constraints and limited infrastructure lead to the significant underutilization of autologous stem cell transplantation.

The results suggest that amyloidosis represents a significant and often underdiagnosed health burden in India, characterized by a predominantly male demographic comprising 70% of cases and a high prevalence of reactive forms resulting from regional endemic diseases.

Thus, the review concludes that clinicians should adopt a more vigilant approach to identifying early-onset symptoms of protein deposition to facilitate timely intervention in a landscape where diagnostic delays remain common.

While the review is limited by its dependence on retrospective studies, which introduces inherent variability in presentation and outcomes, there is an attractive opportunity for future prospective research to better define the epidemiology and improve treatment outcomes across India.

Reference

Mirgh S, Yanamandra U, Vishvanathan GK, et al. Clinical Perspectives on Amyloidosis in India: A Systematic Literature Review. Clinical Lymphoma, Myeloma & Leukemia. 2025;25(9):e675-e684.