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Hagen P, D'Souza A. Autologous stem cell transplantation in AL amyloidosis: Muddy waters. Blood Rev 2024:101228. [PMID: 39179452 DOI: 10.1016/j.blre.2024.101228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/26/2024]
Abstract
Immunoglobulin light chain (AL) amyloidosis is a malignant plasma cell dyscrasia causing multi-organ morbidity. High dose melphalan and autologous stem cell transplantation (ASCT) is a preferred consolidation approach and is safe with improved patient selection criteria. With the advent of bortezomib and daratumumab based induction therapy, nearly all patients can achieve deep hematological responses but follow up for daratumumab based induction is short. Consequently, the traditional approach of induction followed by ASCT is called into question. Given the multi-organ involvement of AL, endpoints beyond depth of response and hematological progression free survival (PFS) are important. Major organ dysfunction PFS (MOD-PFS) adds to PFS and is a composite endpoint of PFS, renal and cardiac organ progression, and overall survival. It is currently unknown which consolidative approach (ASCT or non-ASCT) will generate improved outcomes across the MOD-PFS spectrum a question the recently opened S2213 trial will attempt to answer.
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Affiliation(s)
- Patrick Hagen
- Division of Hematology/Oncology, Department of Medicine, Loyola University, Chicago, United States of America.
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
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2
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Alnasser SM, Alharbi KS, Almutairy AF, Almutairi SM, Alolayan AM. Autologous Stem Cell Transplant in Hodgkin's and Non-Hodgkin's Lymphoma, Multiple Myeloma, and AL Amyloidosis. Cells 2023; 12:2855. [PMID: 38132175 PMCID: PMC10741865 DOI: 10.3390/cells12242855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Human body cells are stem cell (SC) derivatives originating from bone marrow. Their special characteristics include their capacity to support the formation and self-repair of the cells. Cancer cells multiply uncontrollably and invade healthy tissues, making stem cell transplants a viable option for cancer patients undergoing high-dose chemotherapy (HDC). When chemotherapy is used at very high doses to eradicate all cancer cells from aggressive tumors, blood-forming cells and leukocytes are either completely or partially destroyed. Autologous stem cell transplantation (ASCT) is necessary for patients in those circumstances. The patients who undergo autologous transplants receive their own stem cells (SCs). The transplanted stem cells first come into contact with the bone marrow and then undergo engraftment, before differentiating into blood cells. ASCT is one of the most significant and innovative strategies for treating diseases. Here we focus on the treatment of Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma, and AL amyloidosis, using ASCT. This review provides a comprehensive picture of the effectiveness and the safety of ASCT as a therapeutic approach for these diseases, based on the currently available evidence.
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Affiliation(s)
- Sulaiman Mohammed Alnasser
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
| | - Khalid Saad Alharbi
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
| | - Ali F. Almutairy
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
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Yoon SE, Kim D, Choi JO, Min JH, Kim BJ, Kim JS, Lee JE, Choi JY, Jeon ES, Kim SJ, Kim K. A comprehensive overview of AL amyloidosis disease characteristics accumulated over two decades at a single referral center in Korea. Int J Hematol 2022; 117:706-717. [PMID: 36574171 DOI: 10.1007/s12185-022-03525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Characteristics of AL amyloidosis across Asia are not well-described in the literature. Thus, we overviewed the incidence and disease characteristics of AL amyloidosis in Korea. METHODS We collected medical records of 302 AL amyloidosis patients and compared survival outcomes by predominant treatment strategy and at four time points: 1995-2003, 2004-2008, 2009-2013, and 2014-2018. RESULTS The median age was 62 years (36-83). One hundred forty-one patients were classified as stage III (26.3%) or IV (47.9%). The patients diagnosed between 2014 and 2018 survived longer than those diagnosed at other time points due to the introduction of bortezomib (p < 0.01). In addition, patients who received upfront ASCT survived longer than those who received salvage ASCT or chemotherapy alone (p < 0.01). However, most of the 85 patients who experienced early death within 6 months were older than 75 years, had BMI less than 20, and had a high disease burden. CONCLUSIONS The incidence of AL amyloid has increased and survival outcomes have improved gradually, most likely due to introduction of novel agents and upfront ASCT. However, not all patients are suitable for these potent treatment modalities, and avoiding early death within 6 months remains a challenge.
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Affiliation(s)
- Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Eun Lee
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Young Choi
- Departement of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Seok Jeon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-Gu, Seoul, 06351, Korea.
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Incidence, Cause of Death, and Survival of Amyloidosis in Korea: A Retrospective Population-Based Study. INTERNATIONAL JOURNAL OF HEART FAILURE 2021; 3:172-178. [PMID: 36262641 PMCID: PMC9536655 DOI: 10.36628/ijhf.2021.0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 12/17/2022]
Abstract
Background and Objectives We sought to assess incidence, cause of death, and survival for amyloidosis. We acquired amyloidosis data from the National Health Insurance Service in Korea from 2006 through 2017 (n=2,233; male 53.5%). Methods We calculated the age-standardized incidence rate, analyzed the survival rate (SR) using the Kaplan-Meier method, and analyzed the death risk using Cox proportional hazards methods. Results The mean age was 57.0±16.7 years in males and 56.8±15.6 years in females (p=0.795). The proportion of death was 34.7%. The causes of death were endocrine, nutritional, and metabolic diseases (33.9%), malignant neoplasm (20.8%), and diseases of the circulatory system (9.68%). The overall age-standardized incidence rate was 0.47 persons per 100,000 persons in 2017. Overall, the 10-year SR for amyloidosis was 57.7%. Adjusted hazard ratios were 9.16 among 40s′, 16.1 among 50s′, 30.3 among 60s′, 48.7 among 70s′, 80.1 among people 80 years or older, and 1.21 in the medium-level socioeconomic position group. Conclusions The age-standardized incidence rate of amyloidosis was about 0.5 persons per 100,000 persons in 2017. The 10-year SR of amyloidosis was about 58%. The most common cause of death was endocrine, nutritional, and metabolic diseases. The risk of death from amyloidosis increased with age and medium socioeconomic position.
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Vaxman I, Dispenzieri A, Muchtar E, Gertz M. New developments in diagnosis, risk assessment and management in systemic amyloidosis. Blood Rev 2019; 40:100636. [PMID: 31706583 DOI: 10.1016/j.blre.2019.100636] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/19/2019] [Accepted: 10/29/2019] [Indexed: 12/12/2022]
Abstract
Amyloidosis is a group of disorders characterized by a misfolded protein that deposits in organs and compromise their function. Clinician should have a high index of suspicion because in most cases, the clinical picture is non-specific. Typing of amyloid is of utmost importance and should be an integral part of accurately diagnosing a patient. AL amyloidosis is the most common systemic amyloidosis in the western world in which the misfolded proteins are immunoglobulin light chains secreted by clonal plasma cells. New data about prognostication of AL amyloidosis patients are accumulating. The treatment goal is to eradicate the amyloidogenic plasma cell clone, by using high dose melphalan and/or novel agents (proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies against CD38). Early diagnosis is important for effectively treating the patient as late diagnosis hampers chances for organ recovery. ATTR amyloidosis is less recognized but is increasingly seen due to better recognition and improved diagnostic tools. New data about treatment options (patisiran, inotersen and tafamidis) have recently been published and are discussed.
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Affiliation(s)
- Iuliana Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA; Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel; Israel Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | | | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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Wisniowski B, McLeod DSA, Adams R, Harvey Y, Brown I, McGuire L, Armes J, Mollee P. The epidemiology of amyloidosis in Queensland, Australia. Br J Haematol 2019; 186:829-836. [PMID: 31148162 DOI: 10.1111/bjh.16000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/11/2019] [Indexed: 11/30/2022]
Abstract
Published studies on the epidemiology of amyloidosis have relied on death certificate data for case ascertainment. We estimated the incidence and mortality burden of amyloidosis among residents of the Australian state, Queensland, aged ≥20 years for the years 1999-2013 based on case ascertainment from histopathology reports. Information systems for participating laboratories were scrutinised to identify histopathology reports that documented a diagnosis of amyloidosis. Case mortality status was determined via linkage to the National Death Index. A total of 447 cases of amyloidosis were identified, with a median age at diagnosis of 66 years. A plasma cell dyscrasia was identified in 72% of patients who had paraprotein studies performed. The estimated incidence for Queenslanders aged ≥20 years was 12·1 cases per million person years. The median survival was 2·45 years. Age at diagnosis, presence of a paraprotein, earlier year of diagnosis, and inner regional location of residence (compared with residence in a major city) were independently associated with reduced survival. Our data confirms previously reported incidence data for amyloidosis of approximately 10 cases per million patient years and indicates that survival for Queensland patients with amyloidosis is improving, though it remains poor for the elderly and patients with AL amyloidosis.
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Affiliation(s)
- Brendan Wisniowski
- Pathology Queensland, Woolloongabba, Queensland, Australia.,School of Medicine, University of Queensland, Saint Lucia, Queensland, Australia
| | - Donald S A McLeod
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Rebecca Adams
- Pathology Queensland, Woolloongabba, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,QML Pathology, Mansfield, Queensland, Australia
| | - Yasmin Harvey
- Sullivan Nicolaides Pathology, Bowen Hills, Queensland, Australia
| | - Ian Brown
- Envoi Pathology, Kelvin Grove, Queensland, Australia
| | | | - Jane Armes
- Mater Health Services, South Brisbane, Queensland, Australia
| | - Peter Mollee
- Pathology Queensland, Woolloongabba, Queensland, Australia.,School of Medicine, University of Queensland, Saint Lucia, Queensland, Australia
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When Monoclonal Gammopathy is of Renal Significance: A Case Study of Crystalglobulinemia From Chicago Multiple Myeloma Rounds. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e251-e258. [PMID: 30987953 DOI: 10.1016/j.clml.2019.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 12/22/2022]
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8
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Afrough A, Saliba RM, Hamdi A, Honhar M, Varma A, Cornelison AM, Rondon G, Parmar S, Shah ND, Bashir Q, Hosing C, Popat U, Weber DM, Thomas S, Orlowski RZ, Champlin RE, Qazilbash MH. Impact of Induction Therapy on the Outcome of Immunoglobulin Light Chain Amyloidosis after Autologous Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:2197-2203. [DOI: 10.1016/j.bbmt.2018.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/08/2018] [Indexed: 11/29/2022]
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Adverse Prognostic Factors for Morbidity and Mortality During Peripheral Blood Stem Cell Mobilization in Patients with Light Chain Amyloidosis. Biol Blood Marrow Transplant 2017; 24:815-819. [PMID: 29223373 DOI: 10.1016/j.bbmt.2017.11.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/28/2017] [Indexed: 11/24/2022]
Abstract
Patients with immunoglobulin light chain (AL) amyloidosis undergoing peripheral blood hematopoietic stem cell (PBSC) mobilization for autologous hematopoietic stem cell transplantation (auto-HCT) can experience significant morbidity and mortality. The purpose of this study was to characterize the adverse events and identify prognostic factors associated with the development of morbidity and mortality in patients with AL amyloidosis who had begun PBSC mobilization for auto-HCT. A retrospective study was performed in 101 consecutive patients with AL amyloidosis who underwent PBSC mobilization for auto-HCT between January 2006 and December 2013. A composite primary endpoint of morbidity and mortality during PBSC mobilization was used. Forty-one patients (41%) experienced at least 1 adverse event, including 4 deaths during PBSC mobilization. Adverse events included in this composite endpoint were cardiac events, thromboembolic events, bleeding events, unplanned hospitalization, weight gain >2% necessitating diuretic intervention, and death. Low serum albumin levels, elevated N-terminal pro-brain natriuretic peptide, and increased interventricular septal thickness were significantly associated with the composite primary endpoint (P = .024, .001, and .006, respectively). The median progression-free survival from the start of PBSC mobilization was 4.7 years, and the median overall survival was 6.5 years. In general, PBSC mobilization is associated with minimal complications, but patients with AL amyloidosis can experience more frequent and severe complications, such as volume overload and weight gain. Careful patient selection is warranted in patients with AL amyloidosis before proceeding to PBSC mobilization and auto-HCT.
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10
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Badar T, Cornelison AM, Shah ND, Bashir Q, Parmar S, Patel K, Hosing C, Popat U, Weber DM, Thomas SK, Shah JJ, Orlowski RZ, Champlin RE, Qazilbash MH. Outcome of patients with systemic light chain amyloidosis with concurrent renal and cardiac involvement. Eur J Haematol 2016; 97:342-7. [DOI: 10.1111/ejh.12736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Talha Badar
- Department of Stem Cell Transplantation and Cellular Therapy; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Amanda Megan Cornelison
- Department of Stem Cell Transplantation and Cellular Therapy; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Nina D. Shah
- Department of Stem Cell Transplantation and Cellular Therapy; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Simrit Parmar
- Department of Stem Cell Transplantation and Cellular Therapy; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Krina Patel
- Department of Stem Cell Transplantation and Cellular Therapy; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Chitra Hosing
- Department of Stem Cell Transplantation and Cellular Therapy; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Donna M. Weber
- Department of Lymphoma and Myeloma; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Sheeba K. Thomas
- Department of Lymphoma and Myeloma; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Jatin J. Shah
- Department of Lymphoma and Myeloma; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Robert Z. Orlowski
- Department of Lymphoma and Myeloma; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Richard E. Champlin
- Department of Stem Cell Transplantation and Cellular Therapy; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Muzaffar H. Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy; University of Texas MD Anderson Cancer Center; Houston TX USA
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11
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Kastritis E, Dimopoulos MA. Recent advances in the management of AL Amyloidosis. Br J Haematol 2015; 172:170-86. [DOI: 10.1111/bjh.13805] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Efstathios Kastritis
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens; School of Medicine; Athens Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens; School of Medicine; Athens Greece
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12
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Sanchorawala V, Brauneis D, Shelton AC, Lo S, Sun F, Sloan JM, Quillen K, Seldin DC. Induction Therapy with Bortezomib Followed by Bortezomib-High Dose Melphalan and Stem Cell Transplantation for Light Chain Amyloidosis: Results of a Prospective Clinical Trial. Biol Blood Marrow Transplant 2015; 21:1445-51. [PMID: 25858810 DOI: 10.1016/j.bbmt.2015.04.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/01/2015] [Indexed: 12/20/2022]
Abstract
The depth of hematologic response has been shown to correlate with survival and organ responses for patients with light chain (AL) amyloidosis. We conducted a prospective trial of 2 cycles of induction with bortezomib and dexamethasone on a twice a week schedule followed by conditioning with bortezomib and high-dose melphalan (HDM) and autologous stem cell transplantation (SCT). The objectives were hematologic responses, tolerability, and survival. Thirty-five patients were enrolled from 2010 to 2013. Of these, 30 proceeded with SCT, whereas 5 did not because of clinical deterioration during induction (n = 3) or complications after stem cell collection (n = 2). Two patients developed features of an autologous graft-versus-host disease-like syndrome post-SCT, which responded to steroids; no other unusual complications were seen. Treatment-related mortality occurred in 8.5% (3/35). Hematologic responses were achieved by 100% of the 27 assessable patients (63% complete response, 37% very good partial response [VGPR]) who completed the planned treatment. By intention-to-treat, hematologic responses occurred in 77% of patients (49% complete response, 29% VGPR). With a median follow-up of 36 months, the median overall survival and progression-free survival were not reached. In conclusion, incorporating bortezomib into induction and conditioning yielded a high rate of hematologic responses after HDM/SCT in patients with AL amyloidosis.
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Affiliation(s)
- Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.
| | - Dina Brauneis
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Anthony C Shelton
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Stephen Lo
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Fangui Sun
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - J Mark Sloan
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Karen Quillen
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - David C Seldin
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
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Hazenberg BPC, Croockewit A, van der Holt B, Zweegman S, Bos GMJ, Delforge M, Raymakers RAP, Sonneveld P, Vellenga E, Wijermans PW, von dem Borne PA, van Oers MH, de Weerdt O, Spoelstra FM, Lokhorst HM. Extended follow up of high-dose melphalan and autologous stem cell transplantation after vincristine, doxorubicin, dexamethasone induction in amyloid light chain amyloidosis of the prospective phase II HOVON-41 study by the Dutch-Belgian Co-operative Trial Group for Hematology Oncology. Haematologica 2015; 100:677-82. [PMID: 25661441 DOI: 10.3324/haematol.2014.119198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/29/2015] [Indexed: 12/30/2022] Open
Abstract
In a prospective multicenter phase II study, we evaluated the effect of three courses of vincristine, doxorubicin and dexamethasone followed by high-dose melphalan and autologous stem cell transplantation on an intention-to-treat basis. Sixty-nine newly diagnosed patients with amyloid light chain amyloidosis were included between November 2000 and January 2006: 37 men and 32 women with a median age of 56 years, including 46% of patients with cardiac and 22% of patients with involvement of 3 or 4 organs. Initial results presented in 2008 showed a 4-year overall survival rate of 62% among all the patients, while the 4-year survival rate after transplantation was 78%. Here we report the long-term follow-up data after a median follow up of 115 months of the patients still alive. Median survival of all patients was 96 months from registration and for the transplanted patients ten years from the date of transplantation. Twelve (12%) patients died during induction therapy with vincristine, doxorubicin and dexamethasone, including 8 patients (12%) due to treatment-related mortality. Two patients died within one month following high-dose melphalan. We conclude that vincristine, doxorubicin and dexamethasone should not be applied as induction therapy for intensification in amyloid light chain amyloidosis. However, a 2-step approach consisting of a non-intensive less toxic induction therapy followed by high-dose melphalan and autologous stem cell transplantation may result in extended survival in newly diagnosed patients with amyloid light chain amyloidosis (clinicaltrials.gov identifier: 01207094).
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Affiliation(s)
| | | | | | - Sonja Zweegman
- VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | - Edo Vellenga
- University Medical Center Groningen, The Netherlands
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14
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Superior efficacy but higher cost of plerixafor and abbreviated-course G-CSF for mobilizing hematopoietic progenitor cells (HPC) in AL amyloidosis. Bone Marrow Transplant 2015; 50:610-2. [PMID: 25621807 DOI: 10.1038/bmt.2014.318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Amiloidosis. ¿Podemos tener esperanzas? Rev Clin Esp 2015; 215:27-8. [DOI: 10.1016/j.rce.2014.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/19/2014] [Indexed: 11/18/2022]
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