Bone marrow plasma cells 20% or greater discriminate presentation, response, and survival in AL amyloidosis

Eli Muchtar, Morie A. Gertz, Taxiarchis V. Kourelis, Surbhi Sidana, Ronald S. Go, Martha Q. Lacy, Francis K. Buadi, David Dingli, Suzanne R. Hayman, Prashant Kapoor, Nelson Leung, Amie Fonder, Miriam Hobbs, Yi Lisa Hwa, Wilson Gonsalves, Rahma Warsame, Stephen Russell, John A. Lust, Yi Lin, Steven ZeldenrustS. Vincent Rajkumar, Robert A. Kyle, Shaji K. Kumar, Angela Dispenzieri

Research output: Contribution to journalArticle

Abstract

We explored the association between bone marrow plasma cells (BMPCs) and disease presentation and outcome among 1574 AL patients. Three BMPC groups were formulated: <5% (n = 231, 15% of study population), 5–19% (n = 1045, 66%), and ≥20% (n = 298, 19%). Heart and renal involvement were more and less prevalent, respectively, with increasing BMPCs. Patients with ≥20% BMPCs had higher likelihood for classic myeloma phenotype with less skewed lambda restriction, a higher rate of intact immunoglobulin secretion, a lower hemoglobin and higher rates of hypercalcemia and bone lytic lesions. High-risk cytogenetic abnormalities were more common in ≥20% BMPCs. Complete hematological response was less frequent with rising BMPCs. The median survival was inversely associated with the BMPC groups (81, 33, 12 months for <5%, 5–19%, and ≥20% BMPCs, respectively; P < 0.001). Survival discrimination was maintained at 1-year landmark and in those who achieved a complete response. Multivariate analysis accounting for known prognostic markers yielded an independent prognostic role for ≥20% BMPCs, but not for the other BMPC groups. AL patients with 20% or greater BMPCs have poorer outcome independent of their cardiac risk category and stem cell transplant eligibility. Distinct interventions in these patients should be explored to improve outcome.

Original languageEnglish (US)
JournalLeukemia
DOIs
StateAccepted/In press - Jan 1 2019

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Amyloidosis
Plasma Cells
Bone Marrow Cells
Survival
Bone Marrow Diseases
Hypercalcemia
Chromosome Aberrations
Immunoglobulins
Hemoglobins
Stem Cells
Multivariate Analysis
Transplants
Phenotype
Kidney
Bone and Bones

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Bone marrow plasma cells 20% or greater discriminate presentation, response, and survival in AL amyloidosis. / Muchtar, Eli; Gertz, Morie A.; Kourelis, Taxiarchis V.; Sidana, Surbhi; Go, Ronald S.; Lacy, Martha Q.; Buadi, Francis K.; Dingli, David; Hayman, Suzanne R.; Kapoor, Prashant; Leung, Nelson; Fonder, Amie; Hobbs, Miriam; Lisa Hwa, Yi; Gonsalves, Wilson; Warsame, Rahma; Russell, Stephen; Lust, John A.; Lin, Yi; Zeldenrust, Steven; Rajkumar, S. Vincent; Kyle, Robert A.; Kumar, Shaji K.; Dispenzieri, Angela.

In: Leukemia, 01.01.2019.

Research output: Contribution to journalArticle

Muchtar, E, Gertz, MA, Kourelis, TV, Sidana, S, Go, RS, Lacy, MQ, Buadi, FK, Dingli, D, Hayman, SR, Kapoor, P, Leung, N, Fonder, A, Hobbs, M, Lisa Hwa, Y, Gonsalves, W, Warsame, R, Russell, S, Lust, JA, Lin, Y, Zeldenrust, S, Rajkumar, SV, Kyle, RA, Kumar, SK & Dispenzieri, A 2019, 'Bone marrow plasma cells 20% or greater discriminate presentation, response, and survival in AL amyloidosis', Leukemia. https://doi.org/10.1038/s41375-019-0655-x
Muchtar, Eli ; Gertz, Morie A. ; Kourelis, Taxiarchis V. ; Sidana, Surbhi ; Go, Ronald S. ; Lacy, Martha Q. ; Buadi, Francis K. ; Dingli, David ; Hayman, Suzanne R. ; Kapoor, Prashant ; Leung, Nelson ; Fonder, Amie ; Hobbs, Miriam ; Lisa Hwa, Yi ; Gonsalves, Wilson ; Warsame, Rahma ; Russell, Stephen ; Lust, John A. ; Lin, Yi ; Zeldenrust, Steven ; Rajkumar, S. Vincent ; Kyle, Robert A. ; Kumar, Shaji K. ; Dispenzieri, Angela. / Bone marrow plasma cells 20% or greater discriminate presentation, response, and survival in AL amyloidosis. In: Leukemia. 2019.
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abstract = "We explored the association between bone marrow plasma cells (BMPCs) and disease presentation and outcome among 1574 AL patients. Three BMPC groups were formulated: <5{\%} (n = 231, 15{\%} of study population), 5–19{\%} (n = 1045, 66{\%}), and ≥20{\%} (n = 298, 19{\%}). Heart and renal involvement were more and less prevalent, respectively, with increasing BMPCs. Patients with ≥20{\%} BMPCs had higher likelihood for classic myeloma phenotype with less skewed lambda restriction, a higher rate of intact immunoglobulin secretion, a lower hemoglobin and higher rates of hypercalcemia and bone lytic lesions. High-risk cytogenetic abnormalities were more common in ≥20{\%} BMPCs. Complete hematological response was less frequent with rising BMPCs. The median survival was inversely associated with the BMPC groups (81, 33, 12 months for <5{\%}, 5–19{\%}, and ≥20{\%} BMPCs, respectively; P < 0.001). Survival discrimination was maintained at 1-year landmark and in those who achieved a complete response. Multivariate analysis accounting for known prognostic markers yielded an independent prognostic role for ≥20{\%} BMPCs, but not for the other BMPC groups. AL patients with 20{\%} or greater BMPCs have poorer outcome independent of their cardiac risk category and stem cell transplant eligibility. Distinct interventions in these patients should be explored to improve outcome.",
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AU - Muchtar, Eli

AU - Gertz, Morie A.

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AU - Sidana, Surbhi

AU - Go, Ronald S.

AU - Lacy, Martha Q.

AU - Buadi, Francis K.

AU - Dingli, David

AU - Hayman, Suzanne R.

AU - Kapoor, Prashant

AU - Leung, Nelson

AU - Fonder, Amie

AU - Hobbs, Miriam

AU - Lisa Hwa, Yi

AU - Gonsalves, Wilson

AU - Warsame, Rahma

AU - Russell, Stephen

AU - Lust, John A.

AU - Lin, Yi

AU - Zeldenrust, Steven

AU - Rajkumar, S. Vincent

AU - Kyle, Robert A.

AU - Kumar, Shaji K.

AU - Dispenzieri, Angela

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N2 - We explored the association between bone marrow plasma cells (BMPCs) and disease presentation and outcome among 1574 AL patients. Three BMPC groups were formulated: <5% (n = 231, 15% of study population), 5–19% (n = 1045, 66%), and ≥20% (n = 298, 19%). Heart and renal involvement were more and less prevalent, respectively, with increasing BMPCs. Patients with ≥20% BMPCs had higher likelihood for classic myeloma phenotype with less skewed lambda restriction, a higher rate of intact immunoglobulin secretion, a lower hemoglobin and higher rates of hypercalcemia and bone lytic lesions. High-risk cytogenetic abnormalities were more common in ≥20% BMPCs. Complete hematological response was less frequent with rising BMPCs. The median survival was inversely associated with the BMPC groups (81, 33, 12 months for <5%, 5–19%, and ≥20% BMPCs, respectively; P < 0.001). Survival discrimination was maintained at 1-year landmark and in those who achieved a complete response. Multivariate analysis accounting for known prognostic markers yielded an independent prognostic role for ≥20% BMPCs, but not for the other BMPC groups. AL patients with 20% or greater BMPCs have poorer outcome independent of their cardiac risk category and stem cell transplant eligibility. Distinct interventions in these patients should be explored to improve outcome.

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