Objectives: In our study we evaluated the long term efficacy of protocol with bortezomib in induction and lenalidomide in maintenance for AL renal Amyloidosis transplant-ineligible patients. Methods. A prospective analysis of 16 transplant-ineligible patients with histological diagnosis of renal amyloidosis. All patients had overt nephrotic syndrome. Bortezomib-based (CyBorD) regimen was used for 9 cycles. The patients with PRR were treated with Lenalidomide and dexamethasone.

Results: The mean age was 63±7aa and 7/16 were males. The amyloid deposits were FLC k in 6/16 and lambda in 10/16. At onset the mean proteinuria was 13.1±3.6gr/24h with average MDRD of 37.2ml/min. At onset 3 patients had Myeloma. 3/16 patients died for cardiac arrhythmia. CyBorD regimen was completed in 13/16. After 9 CyBorD cycles: 3/13 showed a Complete Renal Response (CRR) and Hematological Response (CHR); 10/13 showed a Partial Renal Response (PRR) and Partial Hemathological Response (PHR), but one died for Sepsi. The 9 patients in PRR were treated with Lenalidomide. After median 6 cycles 7/9 showed a CRR and CHR. Haemodialysis was started in 2/9. All the patients with CRR have been in remission for 30 months on average. Conclusion. Maintenance therapy with Lenalidomide is effective for complete and sustained renal remission.