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Dispenzieri A, Zonder J, Hoffman J, Wong SW, Liedtke M, Abonour R, D'Souza A, Lee C, Cote S, Potluri R, Ammann E, Tran N, Lam A, Nair S. Real-world treatment patterns, costs, and outcomes in patients with AL amyloidosis: analysis of the Optum EHR and commercial claims databases. Amyloid 2022:1-8. [PMID: 36282014 DOI: 10.1080/13506129.2022.2137400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study characterised real-world treatment patterns, clinical outcomes, and cost-of-illness in patients with light-chain (AL) amyloidosis. METHODS Data were extracted from the US-based Optum® EHR and Clinformatics® Data Mart (claims) databases (2008-2019) for patients newly diagnosed with AL amyloidosis and who initiated anti-plasma cell therapies. Healthcare resource utilisation (HCRU) and related costs were compared across lines of therapy (LOT). Incidences of cardiac and renal failure were evaluated using the Kaplan-Meier method. RESULTS About 1347 patients (EHR, n = 776; claims, n = 571) were included. Median age was 68 years; 56.8% were male. At initial diagnosis, 33.1% and 15.1% of patients had cardiac and renal failure, respectively. Most patients received bortezomib-containing treatment in LOT1 (69%); bortezomib-cyclophosphamide-dexamethasone was most common (26%). HCRU was similar across LOTs. Mean per-patient-per-month and per-patient-per-LOT costs were $19,343 and $105,944 for LOT1, $19,183 and $95,793 for LOT2, and $16,611 and $128,446 for LOT3, respectively. Costs were primarily driven by anti-plasma cell therapies, outpatient visits, and hospitalisations. The 5-year cardiac and renal failure rates following initial diagnosis were 64.5% and 39.0%, respectively. CONCLUSION AL amyloidosis is associated with substantial costs and suboptimal outcomes, highlighting the need for new therapeutic approaches to prevent organ deterioration, and reduce disease burden.
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Affiliation(s)
| | | | - James Hoffman
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Sandra W Wong
- Division of Hematology/Oncology, University of California, San Francisco, CA, USA
| | | | | | - Anita D'Souza
- Froedtert & Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | | | - Sarah Cote
- Janssen Global Services, Raritan, NJ, USA
| | | | | | - NamPhuong Tran
- Janssen Research & Development, LLC, Los Angeles, CA, USA
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Sanchorawala V, Palladini G, Minnema MC, Jaccard A, Lee HC, Gibbs S, Mollee P, Venner C, Lu J, Schönland S, Gatt M, Suzuki K, Kim K, Cibeira MT, Beksac M, Libby E, Valent J, Hungria V, Wong SW, Rosenzweig M, Bumma N, Chauveau D, Gries KS, Fastenau J, Tran NP, Qin X, Vasey SY, Weiss BM, Vermeulen J, Ho KF, Merlini G, Comenzo RL, Kastritis E, Wechalekar AD. Health-related quality of life in patients with light chain amyloidosis treated with bortezomib, cyclophosphamide, and dexamethasone ± daratumumab: Results from the ANDROMEDA study. Am J Hematol 2022; 97:719-730. [PMID: 35293006 DOI: 10.1002/ajh.26536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/02/2022] [Accepted: 02/28/2022] [Indexed: 12/19/2022]
Abstract
In the phase 3 ANDROMEDA trial, patients treated with daratumumab, bortezomib, cyclophosphamide, and dexamethasone (D-VCd) had significantly higher rates of organ and hematologic response compared with patients who received VCd alone. Here, we present patient-reported outcomes (PROs) from the ANDROMEDA trial. PROs were assessed through cycle 6 using three standardized questionnaires. Treatment effect through cycle 6 was measured by a repeated-measures, mixed-effects model. The magnitude of changes in PROs versus baseline was generally low, but between-group differences favored the D-VCd group. Results were generally consistent irrespective of hematologic, cardiac, or renal responses. More patients in the D-VCd group experienced meaningful improvements in PROs; median time to improvement was more rapid in the D-VCd group versus the VCd group. After cycle 6, patients in the D-VCd group received daratumumab monotherapy and their PRO assessments continued, with improvements in health-related quality of life (HRQoL) reported through cycle 19. PROs of subgroups with renal and cardiac involvement were consistent with those of the intent-to-treat population. These results demonstrate that the previously reported clinical benefits of D-VCd were achieved without decrement to patients' HRQoL and provide support of D-VCd in patients with AL amyloidosis.
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Affiliation(s)
- Vaishali Sanchorawala
- Amyloidosis Center, Department of Hematology Boston University School of Medicine and Boston Medical Center Boston Massachusetts USA
| | - Giovanni Palladini
- Department of Molecular Medicine, University of Pavia Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Monique C. Minnema
- Department of Hematology University Medical Center Utrecht Utrecht Netherlands
| | - Arnaud Jaccard
- Service d'hématologie clinique et de thérapie cellulaire CHU de Limoges Limoges France
| | - Hans C. Lee
- Department of Lymphoma and Myeloma, Division of Cancer Medicine University of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Simon Gibbs
- The Victorian and Tasmanian Amyloidosis Service, Department of Haematology Monash University Eastern Health Clinical School Box Hill Victoria Australia
| | - Peter Mollee
- Department of Hematology Princess Alexandra Hospital and University of Queensland Medical School Brisbane Queensland Australia
| | | | - Jin Lu
- Institute of Hematology Peking University People's Hospital Beijing China
| | - Stefan Schönland
- Amyloidosis Center Universitaetsklinikum Heidelberg Medizinische Klinik V Heidelberg Germany
| | - Moshe Gatt
- Hematology Department Hadassah Medical Center Jerusalem Israel
| | - Kenshi Suzuki
- Department of Hematology Japanese Red Cross Central Medical Center, Shibuya Tokyo Japan
| | - Kihyun Kim
- Department of Medicine Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul South Korea
| | - María Teresa Cibeira
- Amyloidosis and Myeloma Unit Hospital Clinic of Barcelona, IDIBAPS Barcelona Spain
| | - Meral Beksac
- Department of Hematology Ankara University Ankara Turkey
| | - Edward Libby
- Division of Medical Oncology, Department of Medicine University of Washington Seattle Washington USA
| | - Jason Valent
- Department of Hematology and Medical Oncology, Taussig Cancer Center Cleveland Clinic Cleveland Ohio USA
| | - Vania Hungria
- Department of Hematology Clinica São Germano São Paulo Brazil
| | - Sandy W. Wong
- UCSF Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - Michael Rosenzweig
- Department of Hematology and Hematopoietic Cell Transplantation, Judy and Bernard Briskin Center for Multiple Myeloma Research City of Hope Duarte California USA
| | - Naresh Bumma
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Dominique Chauveau
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d'Organes CHU de Toulouse Toulouse France
| | | | - John Fastenau
- Janssen Research & Development, LLC Raritan New Jersey USA
| | - Nam Phuong Tran
- Janssen Research & Development, LLC Los Angeles California USA
| | - Xiang Qin
- Janssen Research & Development, LLC Spring House Pennsylvania USA
| | - Sandra Y. Vasey
- Janssen Research & Development, LLC Spring House Pennsylvania USA
| | - Brendan M. Weiss
- Janssen Research & Development, LLC Spring House Pennsylvania USA
| | | | | | - Giampaolo Merlini
- Department of Molecular Medicine, University of Pavia Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Raymond L. Comenzo
- Division of Hematology/Oncology, John C. Davis Myeloma and Amyloid Program Tufts Medical Center Boston Massachusetts USA
| | - Efstathios Kastritis
- Department of Clinical Therapeutics National and Kapodistrian University of Athens School of Medicine Athens Greece
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Maroun BZ, Allam S, Chaulagain CP. Multidisciplinary supportive care in systemic light chain amyloidosis. Blood Res 2022; 57:106-116. [PMID: 35593003 PMCID: PMC9242830 DOI: 10.5045/br.2022.2021227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/30/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
The immunoglobulin light-chain amyloidosis is a multisystemic disease which manifests by damage to the vital organs by light chain-derived amyloid fibril. Traditionally, the treatment has been directed to the underlying plasma cell clone with or without high dose chemotherapy followed by autologous stem cell transplantation using melphalan based conditioning. Now with the approval of highly tolerable anti-CD38 monoclonal antibody daratumumab based anti-plasma cell therapy in 2021, high rates of hematologic complete responses are possible even in patients who are otherwise deemed not a candidate for autologous stem cell transplantation. However, despite the progress, there remains a limitation in the strategies to improve symptoms particularly in patients with advanced cardiac involvement, those with nephrotic syndrome and autonomic dysfunction due to underlying systemic AL amyloidosis. The symptoms can be an ordeal for the patients and their caregivers and effective strategies are urgently needed to address them. The supportive care is aimed to counteract the symptoms of the disease and the effects of the treatment on involved organs’ function and preserve patients’ quality of life. Here we discuss multidisciplinary approach in a system-based fashion to address the symptom management in this dreadful disease. In addition to achieving excellent anti-plasma cell disease control, using treatment directed to remove amyloid from the vital organs can theoretically hasten recovery of the involved organs thereby improving symptoms at a faster pace. Ongoing phase III clinical trials of CAEL-101 and Birtamimab will address this question.
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Affiliation(s)
- Bou Zerdan Maroun
- Department of Hematology-Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston FL, USA
| | - Sabine Allam
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Chakra P Chaulagain
- Department of Hematology-Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston FL, USA
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Clinical and Radiological Features of Intramuscular Orbital Amyloidosis: A Case Series and Literature Review. Ophthalmic Plast Reconstr Surg 2021; 38:234-241. [PMID: 34516528 DOI: 10.1097/iop.0000000000002061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Orbital amyloidosis of the extraocular muscles (EOMs) is a rare condition, and its clinicoradiological features are not well elucidated. This study describes the characteristic clinical signs, MRI features, and potential treatment options. METHODS Retrospective multicenter case series and literature review of EOM amyloidosis. RESULTS Five cases were identified for inclusion. Common clinical findings were diplopia, ophthalmoplegia, and proptosis. Systemic amyloidosis was more likely to present with multiple muscle involvement, but no particular pattern was observed with localized disease. On MRI, amyloid deposition was characterized as a heterogeneous intramuscular mass with T2 hypointensity and post contrast enhancement. Management is dependent on the extent of disease and functional impairment; options include surgical debulking and radiation therapy. CONCLUSION EOM amyloidosis is uncommon. The combination of clinical and radiologic findings described in this study should lead to its clinical suspicion.
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Cibeira MT, Ortiz-Pérez JT, Quintana LF, Fernádez de Larrea C, Tovar N, Bladé J. Supportive Care in AL Amyloidosis. Acta Haematol 2020; 143:335-342. [PMID: 32235118 DOI: 10.1159/000506760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/17/2022]
Abstract
Immunoglobulin light-chain (AL) amyloidosis is a systemic disease characterized by the production and deposition of light chain-derived amyloid fibrils in different organs. Prompt treatment directed to the underlying plasma cell clone is crucial in order to achieve a rapid, deep and durable hematologic response. The decrease in the production of the amyloidogenic light chains is a required condition to obtain the organ response, which is commonly delayed. Meanwhile, supportive treatment is aimed to maintain quality of life of these patients and preserve their involved organs' function. From simple measures, such as salt restriction or compressive stockings, to very complex interventions, such as heart transplantation in very selected patients with isolated severe cardiac involvement, this supportive care is essential and has to be necessarily included in the multidisciplinary management of this disease.
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Affiliation(s)
- M Teresa Cibeira
- Hematology Department, Amyloidosis and Myeloma Unit, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain,
| | - José T Ortiz-Pérez
- Cardiology Department, Amyloidosis and Myeloma Unit, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Luis F Quintana
- Nephrology Department, Amyloidosis and Myeloma Unit, Complex Glomerular Disease Unit (CSUR), Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Carlos Fernádez de Larrea
- Hematology Department, Amyloidosis and Myeloma Unit, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Natalia Tovar
- Hematology Department, Amyloidosis and Myeloma Unit, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Joan Bladé
- Hematology Department, Amyloidosis and Myeloma Unit, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
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Epidemiology of AL amyloidosis: a real-world study using US claims data. Blood Adv 2019; 2:1046-1053. [PMID: 29748430 DOI: 10.1182/bloodadvances.2018016402] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/17/2018] [Indexed: 12/19/2022] Open
Abstract
Amyloid light-chain (AL) amyloidosis is a rare disease caused by extracellular deposition of misfolded immunoglobulin light chains. This study aimed to provide an up-to-date estimate of prevalence and incidence of AL amyloidosis in the United States. Using claims databases from years 2007 to 2015, adults ≥18 years old with AL amyloidosis were included if they had (1) at least 1 inpatient or 2 outpatient claims consistent with AL amyloidosis and (2) received 1 AL-specific treatment. Prevalence was calculated as the number of AL patients divided by the number of enrollees on June 30th of each calendar year. Incidence was calculated as the number of patients with AL who were disease-free and enrolled with a health plan for 1 year prior, divided by the number of enrollees with enrollment from July 1st of the previous year to June 30th of each calendar year. The prevalence of AL amyloidosis increased significantly between 2007 and 2015, from 15.5 cases per million in 2007 to 40.5 in 2015, an annual percentage change (APC) of 12% (P < .001). The incidence ranged from 9.7 to 14.0 cases per million person-years (APC, 3%; P = .114) with no statistically significant increase. There was an increase in AL amyloidosis prevalence over a 9-year period coupled with stable incidence rates. Although there is no diagnosis code specific to AL amyloidosis and no validated method for identifying this condition using claims data, extrapolating from our data, there are at least 12 000 adults in the United States living with AL amyloidosis, and the number seems likely to rise.
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Rutten KHG, Raymakers RAP, Hazenberg BPC, Nienhuis HLA, Vellenga E, Minnema MC. Haematological response and overall survival in two consecutive Dutch patient cohorts with AL amyloidosis diagnosed between 2008 and 2016. Amyloid 2018; 25:227-233. [PMID: 30513220 DOI: 10.1080/13506129.2018.1536043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although survival has improved in recent decades, the short-term prognosis of patients with immunoglobulin light chain (AL) amyloidosis remains grim. We aimed to assess overall survival (OS) of AL amyloidosis patients by comparing cohorts in two consecutive time periods. METHODS Data were collected and compared on 126 patients from two tertiary referral centres in The Netherlands during the time periods 2008-2012 and 2013-2016. RESULTS There was a non-significant trend to improved 6-month OS in the last cohort (78% vs. 67%, p = .216, crude odds ratio 1.66, 95%CI 0.74-3.70, adjusted odds ratio 2.22, 95%CI 0.88-5.56). Patients in this cohort had higher Mayo risk scores (stage III 40% vs. 24%, p < .001 and revised stage IV 14% vs. 11%, p < .001), higher use of bortezomib (50% vs. 30%), and better haematological response (complete response/very good partial response in 39% vs. 27%, p < .001). Diagnostic delay was similar in both time periods. CONCLUSIONS In the 2013-2016 cohort there was a trend toward improved 6-month OS, and an improved haematological response. Patients in this cohort had more advanced cardiac disease and received bortezomib more frequently, but diagnostic delay was similar to the 2008-2012 cohort. For further prognostic improvement, practitioners should be more alert, especially for cardiac amyloidosis.
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Affiliation(s)
- Karlijn H G Rutten
- a Department of Haematology , Utrecht University, University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Reinier A P Raymakers
- a Department of Haematology , Utrecht University, University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Bouke P C Hazenberg
- b Department of Rheumatology & Clinical Immunology , University of Groningen, University Medical Centre Groningen , Groningen , The Netherlands
| | - Hans L A Nienhuis
- b Department of Rheumatology & Clinical Immunology , University of Groningen, University Medical Centre Groningen , Groningen , The Netherlands
| | - Edo Vellenga
- c Department of Haematology , University of Groningen, University Medical Centre Groningen , Groningen , The Netherlands
| | - Monique C Minnema
- a Department of Haematology , Utrecht University, University Medical Centre Utrecht , Utrecht , The Netherlands
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Quock TP, Chang E, Munday JS, D'Souza A, Gokhale S, Yan T. Mortality and healthcare costs in Medicare beneficiaries with AL amyloidosis. J Comp Eff Res 2018; 7:1053-1062. [PMID: 30354284 DOI: 10.2217/cer-2018-0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIMS Examine mortality and healthcare costs in Medicare beneficiaries with newly diagnosed immunoglobulin light chain (AL) amyloidosis. PATIENTS & METHODS Cases were identified in 2012-2015 Medicare 5% data with ≥1 inpatient/≥2 outpatient claims consistent with AL amyloidosis and ≥1 AL-specific treatment. Cases were matched 3:1 with disease-free controls. Descriptive statistics were reported. RESULTS A total of 249 (33.3%) cases were matched to 747 (66.7%) controls. A total of 19.7% of cases died within 1 year of follow-up versus 5.5% of controls; 30.6 versus 11.8% died within 2 years (p < 0.001). Mean (SD) costs in 1-year of follow-up were significantly higher among cases versus controls ($71,040 [65,766] vs $13,722 [27,493]; p < 0.001). CONCLUSION Mortality was nearly four-times higher, and costs nearly five-times higher in beneficiaries with AL amyloidosis versus controls.
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Affiliation(s)
- Tiffany P Quock
- Prothena Biosciences Inc., 331 Oyster Point Boulevard; South San Francisco, CA 94080, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr. Ste. 404; Beverly Hills, CA 90212, USA
| | - Jennifer S Munday
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr. Ste. 404; Beverly Hills, CA 90212, USA
| | - Anita D'Souza
- Medical College of Wisconsin, Milwaukee, 8701 Watertown Plank Road; Milwaukee, WI 53226, USA
| | - Sohum Gokhale
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr. Ste. 404; Beverly Hills, CA 90212, USA
| | - Tingjian Yan
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr. Ste. 404; Beverly Hills, CA 90212, USA
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Abstract
PURPOSE OF REVIEW Myeloma kidney and amyloid light-chain (AL) amyloidosis remain the principal kidney complications of paraproteins. In this review, we update readers to many of the recent advances which have occurred in the care and outcomes for patients with these presentations. RECENT FINDINGS Myeloma kidney has historically caused a severe acute kidney injury with very poor outcomes. The combination of new diagnostic techniques, enabling a rapid diagnosis and novel chemotherapy agents has transformed these poor outcomes for the better. Two multicentre randomized controlled trials have recently evaluated if the removal of free light chains by high cut-off haemodialysis improves renal outcomes beyond effective chemotherapy alone. Although we await the full articles of these studies to be published, abstracts suggested the studies will have contradictory primary results. In the field of AL amyloidosis, there are now novel criteria for the risk stratification of kidney outcomes which can be used in combination with markers of early kidney response to provide clinicians with powerful tools to guide patient discussions. SUMMARY Across both AL amyloidosis and myeloma kidney patient outcomes continue to improve. Principally this improvement has been driven by the continuing development of novel chemotherapy agents in this field.
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Hari P, Lin HM, Asche CV, Ren J, Yong C, Luptakova K, Faller DV, Sanchorawala V. Treatment patterns and health care resource utilization among patients with relapsed/refractory systemic light chain amyloidosis. Amyloid 2018; 25:1-7. [PMID: 29303358 DOI: 10.1080/13506129.2017.1411796] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Treatment for patients with systemic light chain (AL) amyloidosis remains challenging. Our study aims to describe treatment patterns for both newly diagnosed and relapsed/refractory AL (RRAL) amyloidosis, and to assess clinical outcomes, healthcare costs, and resource utilization during the first year following a diagnosis of RRAL amyloidsis. METHODS This was a retrospective observational study of adult patients with AL amyloidosis using the US Optum administrative claims data during 1/1/2008 to 6/30/2015. Diagnosis was based on both ICD-9 codes and treatments with a claim for AL-amyloidosis-specific anticancer systemic agents. RESULTS Of 334 patients with AL amyloidosis, 43.1% were considered as RRAL amyloidosis. The majority (75%) of RRAL amyloidosis patients had organ involvement prior to the second line treatment. Proteasome-inhibitor-based regimens were most frequently used (41.0% for first-line AL, 30.6% for RRAL amyloidosis). Organ deterioration and mortality rates were 49.3% and 10.4%, respectively, during the two years following relapse. The average monthly cost was $14,369 per patient for RRAL amyloidosis including medical costs ($9441) and drug costs ($4928). CONCLUSIONS RRAL amyloidosis is associated with high morbidity from target organ failure and mortality, which emphasizes the need for novel medications to improve care for patients with RRAL amyloidosis.
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Affiliation(s)
- Parameswaran Hari
- a Department of Medicine , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Huamao Mark Lin
- b Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Carl V Asche
- c Center for Outcomes Research, Department of Medicine , University of Illinois College of Medicine at Peoria , Peoria , IL , USA.,d Center for Pharmacoepidemiology and Pharmacoeconomic Research , University of Illinois at Chicago College of Pharmacy , Chicago , IL , USA
| | - Jinma Ren
- c Center for Outcomes Research, Department of Medicine , University of Illinois College of Medicine at Peoria , Peoria , IL , USA
| | - Candice Yong
- b Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Katarina Luptakova
- b Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Douglas V Faller
- b Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Vaishali Sanchorawala
- e Amyloidosis Center , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA
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Gertz MA, Buadi FK, Lacy MQ, Hayman SR. Immunoglobulin Light Chain Amyloidosis (Primary Amyloidosis). Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lin HM, Gao X, Cooke CE, Berg D, Labotka R, Faller DV, Seal B, Hari P. Disease burden of systemic light-chain amyloidosis: a systematic literature review. Curr Med Res Opin 2017; 33:1017-1031. [PMID: 28277869 DOI: 10.1080/03007995.2017.1297930] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A systematic literature review on systemic light chain (AL) amyloidosis was conducted in order to understand the disease burden, and identify unmet medical needs and knowledge gaps. METHODS MEDLINE, Embase and Cochrane databases were searched for English language studies published in the last 10 years using search terms that focused on the clinical, economic, and patient-reported outcome (PRO) aspects of AL amyloidosis. There was a low yield of articles in the economic and PRO categories and additional searches were conducted in clinical conference proceedings, and using Google and Google Scholar. After review, there were 65 articles included for data extraction. RESULTS AL amyloidosis is a rare disorder without any FDA or EMA approved indications for drug therapy. Using off-label therapies, there is a high rate, 42-64%, of non-response or progression, and an associated high mortality. Toxicities during therapy are common with estimates of up to 30-40% of patients experiencing severity of grade 3 or higher. Patients with AL amyloidosis report severe psychological distress, anxiety and clinical depression. CONCLUSIONS There is a deficiency in the literature on the economic costs associated with AL amyloidosis, and information on costs has been derived from studies that examined multiple myeloma or other disease or treatment components common to AL amyloidosis.
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Affiliation(s)
- Huamao Mark Lin
- a Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Xin Gao
- b Pharmerit International , Bethesda , MD , USA
| | | | - Deborah Berg
- a Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Richard Labotka
- a Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Douglas V Faller
- a Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Brian Seal
- a Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
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Hwa YL, Kumar SK, Gertz MA, Lacy MQ, Buadi FK, Kourelis TV, Gonsalves WI, Rajkumar SV, Go RS, Leung N, Kapoor P, Dingli D, Kyle RA, Russell S, lust JA, Hayman SR, Lin Y, Zeldenrust S, Dispenzieri A. Induction therapy pre-autologous stem cell transplantation in immunoglobulin light chain amyloidosis: a retrospective evaluation. Am J Hematol 2016; 91:984-8. [PMID: 27341539 DOI: 10.1002/ajh.24453] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022]
Abstract
There is no consensus on whether patients with immunoglobulin light chain amyloidosis (AL) should receive induction therapy prior to an autologous stem cell transplant (ASCT). This study investigated the relationships between baseline bone marrow plasmacytosis (BMPC), cardiac staging, and pre-transplant induction in AL patients. All patients who received ASCT for AL within 12 months of diagnosis were included. Patient characteristics and outcomes were abstracted. Univariate and multivariate modeling was performed. Among 415 AL patients, 35% had induction prior to ASCT. Post-ASCT hematologic CR plus VGPR rates were significantly higher in those with baseline BMPC ≤ 10% compared to BMPC >10% (58% versus 40%, P = 0.0013). Significant risk factors for lack of attainment of CR included attenuated dose melphalan conditioning, baseline BMPC > 10%, no induction, and male gender. The 5-year OS for the entire group was 65%. On multivariate analysis, risk factors for inferior OS included no induction therapy, advanced AL amyloid staging, BMPC > 10%, attenuated conditioning melphalan dose, and male gender. Patients with Mayo 2012 stage I-II patients with BMPC ≤ 10%, who comprised 56% of the ASCT population fared exceedingly well regardless of whether or not they received induction therapy with a 5-year OS of 81 to 83%. Induction therapy pre-ASCT may improve outcomes among AL patients due to a rapid reduction of toxic light chains or alternatively by elimination of less fit patients by "testing" their ability to tolerate chemotherapy. Prospective studies will be required to sort out these and other questions. Am. J. Hematol. 91:984-988, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yi L. Hwa
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Shaji K. Kumar
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Morie A. Gertz
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Martha Q. Lacy
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | | | | | - Ronald S. Go
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Nelson Leung
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - David Dingli
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Robert A. Kyle
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - John A. lust
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Yi Lin
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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[The usage of Mayo staging system in Chinese patients with primary light chain amyloidosis]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:278-82. [PMID: 27093987 PMCID: PMC7343086 DOI: 10.3760/cma.j.issn.0253-2727.2016.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
目的 探讨梅奥分期系统在中国原发性轻链型淀粉样变患者中的临床应用价值。 方法 回顾性分析2009年1月至2015年6月期间在北京协和医院确诊的具有梅奥分期数据的162例原发性轻链型淀粉样变患者的临床资料。 结果 具有完整梅奥2004分期数据的162例患者中,男101例(62.3%),女61例(37.7%),中位年龄57(20~81)岁;Ⅰ、Ⅱ、Ⅲ期患者分别为44例(27.2%)、69例(42.6%)和49例(30.2%),其中位总生存(OS)时间分别为未达到、23个月和12个月,预计2年OS率分别为87.3%、47.4%和29.2%(P<0.001)。具有完整梅奥2012分期数据的128例患者中,1~4期患者分别为48例(37.5%)、32例(25.0%)、32例(25.0%)和16例(12.5%),其中位OS时间分别为未达到、未达到、13个月和3个月,预计2年OS率分别为94.5%、78.6%、25.9%和24.5%(P<0.001)。 结论 梅奥分期系统对于中国原发性轻链型淀粉样变患者具有重要的预后价值。
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Free light chain testing for the diagnosis, monitoring and prognostication of AL amyloidosis. ACTA ACUST UNITED AC 2016; 54:921-7. [DOI: 10.1515/cclm-2015-0938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/14/2015] [Indexed: 01/05/2023]
Abstract
AbstractThe disease causing agent in systemic AL amyloidosis is a monoclonal immunoglobulin free light chain, or fragments thereof, circulating in the blood. It is not surprising, therefore, that measurement of serum free light chains plays a central role in the management of this disorder. In this paper, we review the utility of the serum free light chain assay in the investigation, prognostication and monitoring of AL amyloidosis. Data on the two currently available commercial assays is compared and some practical applications of the assay’s use are presented. While there are limitations, it is clear that the availability of the free light chain assay in the laboratory is a major advance and plays an essential role in the management of patients with AL amyloidosis.
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