A detailed evaluation of the current renal response criteria in AL amyloidosis: Is it time for a revision?

Nelson Leung, Siobhan V. Glavey, Shaji K Kumar, Angela Dispenzieri, Francis K. Buadi, David M Dingli, Martha Lacy, Suzanne R. Hayman, John A. Lust, Stephen J Russell, Steven R. Zeldenrust, S Vincent Rajkumar, Morie Gertz

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Organ response correlates with overall survival in patients with immunoglobulin light chain amyloidosis and is the goal of treatment. This study evaluates the current renal response criteria and their ability to predict overall survival. Patients with immunoglobulin light chain amyloidosis who underwent autologous stem cell transplantation between 1995 and 2010 were recruited. Eligibility criteria included >1 g/dL of proteinuria, dialysis independence at baseline and within the first year of autologous stem cell transplantation, and a minimum follow-up of 1 year. Responses were assessed by the best values after autologous stem cell transplantation. The difference between involved and uninvolved serum free light chain levels was used to determine hematologic response. Increases in serum creatinine were calculated from the highest creatinine after autologous stem cell transplantation. Inclusion and exclusion criteria were met by 141 patients. These patients had a median follow-up of 52 months. Superior overall survival was observed in patients with a >75% reduction in proteinuria and those who had a >95% reduction had additional benefits. The overall survival of patients with >50% to ≤75% proteinuria was similar to that of patients with ≤50% reduction. A rise in serum creatinine >25% was not associated with a poorer outcome in patients with a >75% reduction in proteinuria. Deeper hematologic responses were associated with higher rates of proteinuria reduction. These results suggest that further evaluation of the current renal response criteria is needed. In particular, discrimination of the renal response into complete and partial categories and modification of the serum creatinine requirement seem justified.

Original languageEnglish (US)
Pages (from-to)988-992
Number of pages5
JournalHaematologica
Volume98
Issue number6
DOIs
StatePublished - 2013

Fingerprint

Amyloidosis
Kidney
Proteinuria
Stem Cell Transplantation
Creatinine
Immunoglobulin Light Chains
Survival
Serum
Dialysis
Light

ASJC Scopus subject areas

  • Hematology

Cite this

A detailed evaluation of the current renal response criteria in AL amyloidosis : Is it time for a revision? / Leung, Nelson; Glavey, Siobhan V.; Kumar, Shaji K; Dispenzieri, Angela; Buadi, Francis K.; Dingli, David M; Lacy, Martha; Hayman, Suzanne R.; Lust, John A.; Russell, Stephen J; Zeldenrust, Steven R.; Rajkumar, S Vincent; Gertz, Morie.

In: Haematologica, Vol. 98, No. 6, 2013, p. 988-992.

Research output: Contribution to journalArticle

@article{11de57d5140d41c2b64d9041ecc427ba,
title = "A detailed evaluation of the current renal response criteria in AL amyloidosis: Is it time for a revision?",
abstract = "Organ response correlates with overall survival in patients with immunoglobulin light chain amyloidosis and is the goal of treatment. This study evaluates the current renal response criteria and their ability to predict overall survival. Patients with immunoglobulin light chain amyloidosis who underwent autologous stem cell transplantation between 1995 and 2010 were recruited. Eligibility criteria included >1 g/dL of proteinuria, dialysis independence at baseline and within the first year of autologous stem cell transplantation, and a minimum follow-up of 1 year. Responses were assessed by the best values after autologous stem cell transplantation. The difference between involved and uninvolved serum free light chain levels was used to determine hematologic response. Increases in serum creatinine were calculated from the highest creatinine after autologous stem cell transplantation. Inclusion and exclusion criteria were met by 141 patients. These patients had a median follow-up of 52 months. Superior overall survival was observed in patients with a >75{\%} reduction in proteinuria and those who had a >95{\%} reduction had additional benefits. The overall survival of patients with >50{\%} to ≤75{\%} proteinuria was similar to that of patients with ≤50{\%} reduction. A rise in serum creatinine >25{\%} was not associated with a poorer outcome in patients with a >75{\%} reduction in proteinuria. Deeper hematologic responses were associated with higher rates of proteinuria reduction. These results suggest that further evaluation of the current renal response criteria is needed. In particular, discrimination of the renal response into complete and partial categories and modification of the serum creatinine requirement seem justified.",
author = "Nelson Leung and Glavey, {Siobhan V.} and Kumar, {Shaji K} and Angela Dispenzieri and Buadi, {Francis K.} and Dingli, {David M} and Martha Lacy and Hayman, {Suzanne R.} and Lust, {John A.} and Russell, {Stephen J} and Zeldenrust, {Steven R.} and Rajkumar, {S Vincent} and Morie Gertz",
year = "2013",
doi = "10.3324/haematol.2012.079210",
language = "English (US)",
volume = "98",
pages = "988--992",
journal = "Haematologica",
issn = "0390-6078",
publisher = "Ferrata Storti Foundation",
number = "6",

}

TY - JOUR

T1 - A detailed evaluation of the current renal response criteria in AL amyloidosis

T2 - Is it time for a revision?

AU - Leung, Nelson

AU - Glavey, Siobhan V.

AU - Kumar, Shaji K

AU - Dispenzieri, Angela

AU - Buadi, Francis K.

AU - Dingli, David M

AU - Lacy, Martha

AU - Hayman, Suzanne R.

AU - Lust, John A.

AU - Russell, Stephen J

AU - Zeldenrust, Steven R.

AU - Rajkumar, S Vincent

AU - Gertz, Morie

PY - 2013

Y1 - 2013

N2 - Organ response correlates with overall survival in patients with immunoglobulin light chain amyloidosis and is the goal of treatment. This study evaluates the current renal response criteria and their ability to predict overall survival. Patients with immunoglobulin light chain amyloidosis who underwent autologous stem cell transplantation between 1995 and 2010 were recruited. Eligibility criteria included >1 g/dL of proteinuria, dialysis independence at baseline and within the first year of autologous stem cell transplantation, and a minimum follow-up of 1 year. Responses were assessed by the best values after autologous stem cell transplantation. The difference between involved and uninvolved serum free light chain levels was used to determine hematologic response. Increases in serum creatinine were calculated from the highest creatinine after autologous stem cell transplantation. Inclusion and exclusion criteria were met by 141 patients. These patients had a median follow-up of 52 months. Superior overall survival was observed in patients with a >75% reduction in proteinuria and those who had a >95% reduction had additional benefits. The overall survival of patients with >50% to ≤75% proteinuria was similar to that of patients with ≤50% reduction. A rise in serum creatinine >25% was not associated with a poorer outcome in patients with a >75% reduction in proteinuria. Deeper hematologic responses were associated with higher rates of proteinuria reduction. These results suggest that further evaluation of the current renal response criteria is needed. In particular, discrimination of the renal response into complete and partial categories and modification of the serum creatinine requirement seem justified.

AB - Organ response correlates with overall survival in patients with immunoglobulin light chain amyloidosis and is the goal of treatment. This study evaluates the current renal response criteria and their ability to predict overall survival. Patients with immunoglobulin light chain amyloidosis who underwent autologous stem cell transplantation between 1995 and 2010 were recruited. Eligibility criteria included >1 g/dL of proteinuria, dialysis independence at baseline and within the first year of autologous stem cell transplantation, and a minimum follow-up of 1 year. Responses were assessed by the best values after autologous stem cell transplantation. The difference between involved and uninvolved serum free light chain levels was used to determine hematologic response. Increases in serum creatinine were calculated from the highest creatinine after autologous stem cell transplantation. Inclusion and exclusion criteria were met by 141 patients. These patients had a median follow-up of 52 months. Superior overall survival was observed in patients with a >75% reduction in proteinuria and those who had a >95% reduction had additional benefits. The overall survival of patients with >50% to ≤75% proteinuria was similar to that of patients with ≤50% reduction. A rise in serum creatinine >25% was not associated with a poorer outcome in patients with a >75% reduction in proteinuria. Deeper hematologic responses were associated with higher rates of proteinuria reduction. These results suggest that further evaluation of the current renal response criteria is needed. In particular, discrimination of the renal response into complete and partial categories and modification of the serum creatinine requirement seem justified.

UR - http://www.scopus.com/inward/record.url?scp=84878445502&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878445502&partnerID=8YFLogxK

U2 - 10.3324/haematol.2012.079210

DO - 10.3324/haematol.2012.079210

M3 - Article

C2 - 23729727

AN - SCOPUS:84878445502

VL - 98

SP - 988

EP - 992

JO - Haematologica

JF - Haematologica

SN - 0390-6078

IS - 6

ER -