OBJECTIVES: The prognosis for light chain amyloidosis (AL) is generally poor, with the involvement of cardiac, renal and a number of other organs. Little is known about the economic burden of patients with RRAL. The aims of this study were to assess the cumulative healthcare costs and utilization following RRAL. METHODS: This was a retrospective observational study of RRAL using a US administrative claims data during 1/1/2008 to 6/30/2015. Patients with RRAL were identified by presence of ICD-9 diagnosis codes (277.30 or 277.39) and previous lines of treatment following AL diagnosis. Total and RRAL-related healthcare costs and utilization were reported during 1 year, 2 years and 3 years post-RRAL. The Kaplan-Meier Sample Average approach was used to estimate mean costs from RRAL. RESULTS: A total of 144 RRAL patients were identified. The average age was 65.0 (SD 11.1) years, 59.0% were males.The average 1-, 2- and 3-year cumulative healthcare costs were $139,143, $275,391 and $342,349, respectively. During the first year following relapse or refractory state, the average total cost per patient per month was $14,369, including $5,514 cost with RRAL as first or second diagnosis code; the average health resource utilizations included 0.16 inpatient admissions, 3.02 outpatient or office visits, 0.14 visits of emergency room, and 0.05 admission of intensive care unit per patient per month; the average length of stay (LOS) for inpatient admission was 8.2 days. CONCLUSIONS: Following RRAL, the average health resource utilization was substantial as was the average LOS for inpatient admission. A significant portion of the costs were driven by inpatient, outpatient and pharmacy cost and were heart or renal-related. The results suggest a significant economical burden and unmet need for patients with RRAL. New therapies which offer better clinical outcomes with less toxicity are needed to improve care for patients with AL amyloidosis.