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Background: Patients with AL amyloidosis and congestive heart failure have a very poor prognosis. To date, the recovery of these patients has not been described in detail. Objective: To determine the frequency and characteristics of regression of disease in patients with congestive heart failure due to AL amyloidosis. Design Review of patients with systemic AL amyloidosis. Setting An international referral center for amyloidosis in the United States. Patients: 140 patients with congestive heart failure due to AL amyloidosis who were seen between 1983 and 1994. Measurements: Functional status, Doppler echocardiography, and objective measurements of disease activity. Results: 3 of 140 patients (2.1%) had marked resolution of congestive heart failure and evidence for remission of disease activity. All 3 had been treated with melphalan. Conclusions: Melphalan appears to have had a favorable effect in 3 patients with AL amyloidosis and heart failure. The abolition of light chains that was seen in these 3 patients suggests that light-chain toxicity may play a role in the genesis of heart failure in patients with AL amyloidosis., Melphalan appears to be effective in reversing congestive heart failure in patients with AL amyloidosis. The medical records of 140 patients with AL amyloidosis were reviewed and patient characteristics of three of these patients with congestive heart failure reversal (2.1%) were highlighted. All three of these patients had received melphalan chemotherapy treatment. The rest of the patients had been treated with only colchicine. None of the three patients had evidence of any free light protein chains in their blood samples after treatment.