Improved outcomes for newly diagnosed AL amyloidosis between 2000 and 2014

Cracking the glass ceiling of early death

Eli Muchtar, Morie Gertz, Shaji K Kumar, Martha Lacy, David M Dingli, Francis K. Buadi, Martha Grogan, Suzanne R. Hayman, Prashant Kapoor, Nelson Leung, Amie Fonder, Miriam Hobbs, Yi Lisa Hwa, Wilson Gonsalves, Rahma Warsame, Taxiarchis Kourelis, Stephen J Russell, John A. Lust, Yi Lin, Ronald S. Go & 4 others Steven Zeldenrust, Robert A. Kyle, S Vincent Rajkumar, Angela Dispenzieri

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

In light of major advances in immunoglobulin light chain (AL) amyloidosis, we evaluated the trends in presentation, management, and outcome among 1551 newly diagnosed AL amyloidosis patients seen in our institution from 2000 to 2014. As compared with the 2 intervals 2000-2004 and 2005-2009, patients diagnosed in 2010-2014 were less likely to have >2 involved organs. Utilization of autologous stemcell transplant (ASCT)wassimilar across all periods, about one-third of patients, but there was an increase in the use of pre- ASCT bortezomib induction and of unattenuated melphalan conditioning in 2010-2014 compared with earlier periods. Non-ASCT first-line regimen changed with 65% of patients in 2010-2014 received bortezomib-based therapy, 79% of patients in 2005-2009 received melphalan-dexamethasone, and 64% of patients in 2000-2004 received melphalan-prednisone. The rate of better than very good partial response (VGPR) was higher inmore recent periods (66% vs 58% vs 51%;P5.001), a change largely driven by improved VGPR rates in the non-ASCT population. Overall survival (OS) has improved, with inflection points for improvement differing for the ASCT and non-ASCT groups. In the ASCT population, the greatest gainswere after 2010 (4-year OS, 91%comparedwith 73% and 65%). In the non-ASCT group, greatest gains were after 2005 (4-year OS, 38%, 32%, and 16%). Fewer patients died within 6 months of diagnosis in the 2 later periods (24% vs25%vs 37%;P<.001). Overall, outcomes among patients with AL amyloidosis have improved with earlier diagnosis, higher rates of VGPR, lower early mortality, and improved OS.

Original languageEnglish (US)
Pages (from-to)2111-2119
Number of pages9
JournalBlood
Volume129
Issue number15
DOIs
StatePublished - Apr 13 2017

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Transplants
Autografts
Amyloidosis
Melphalan
Immunoglobulin Light Chains
Survival
Prednisone
Dexamethasone
Population
Early Diagnosis
Mortality
Bortezomib

ASJC Scopus subject areas

  • Immunology
  • Biochemistry
  • Hematology
  • Cell Biology

Cite this

Improved outcomes for newly diagnosed AL amyloidosis between 2000 and 2014 : Cracking the glass ceiling of early death. / Muchtar, Eli; Gertz, Morie; Kumar, Shaji K; Lacy, Martha; Dingli, David M; Buadi, Francis K.; Grogan, Martha; Hayman, Suzanne R.; Kapoor, Prashant; Leung, Nelson; Fonder, Amie; Hobbs, Miriam; Hwa, Yi Lisa; Gonsalves, Wilson; Warsame, Rahma; Kourelis, Taxiarchis; Russell, Stephen J; Lust, John A.; Lin, Yi; Go, Ronald S.; Zeldenrust, Steven; Kyle, Robert A.; Rajkumar, S Vincent; Dispenzieri, Angela.

In: Blood, Vol. 129, No. 15, 13.04.2017, p. 2111-2119.

Research output: Contribution to journalArticle

Muchtar, Eli ; Gertz, Morie ; Kumar, Shaji K ; Lacy, Martha ; Dingli, David M ; Buadi, Francis K. ; Grogan, Martha ; Hayman, Suzanne R. ; Kapoor, Prashant ; Leung, Nelson ; Fonder, Amie ; Hobbs, Miriam ; Hwa, Yi Lisa ; Gonsalves, Wilson ; Warsame, Rahma ; Kourelis, Taxiarchis ; Russell, Stephen J ; Lust, John A. ; Lin, Yi ; Go, Ronald S. ; Zeldenrust, Steven ; Kyle, Robert A. ; Rajkumar, S Vincent ; Dispenzieri, Angela. / Improved outcomes for newly diagnosed AL amyloidosis between 2000 and 2014 : Cracking the glass ceiling of early death. In: Blood. 2017 ; Vol. 129, No. 15. pp. 2111-2119.
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abstract = "In light of major advances in immunoglobulin light chain (AL) amyloidosis, we evaluated the trends in presentation, management, and outcome among 1551 newly diagnosed AL amyloidosis patients seen in our institution from 2000 to 2014. As compared with the 2 intervals 2000-2004 and 2005-2009, patients diagnosed in 2010-2014 were less likely to have >2 involved organs. Utilization of autologous stemcell transplant (ASCT)wassimilar across all periods, about one-third of patients, but there was an increase in the use of pre- ASCT bortezomib induction and of unattenuated melphalan conditioning in 2010-2014 compared with earlier periods. Non-ASCT first-line regimen changed with 65{\%} of patients in 2010-2014 received bortezomib-based therapy, 79{\%} of patients in 2005-2009 received melphalan-dexamethasone, and 64{\%} of patients in 2000-2004 received melphalan-prednisone. The rate of better than very good partial response (VGPR) was higher inmore recent periods (66{\%} vs 58{\%} vs 51{\%};P5.001), a change largely driven by improved VGPR rates in the non-ASCT population. Overall survival (OS) has improved, with inflection points for improvement differing for the ASCT and non-ASCT groups. In the ASCT population, the greatest gainswere after 2010 (4-year OS, 91{\%}comparedwith 73{\%} and 65{\%}). In the non-ASCT group, greatest gains were after 2005 (4-year OS, 38{\%}, 32{\%}, and 16{\%}). Fewer patients died within 6 months of diagnosis in the 2 later periods (24{\%} vs25{\%}vs 37{\%};P<.001). Overall, outcomes among patients with AL amyloidosis have improved with earlier diagnosis, higher rates of VGPR, lower early mortality, and improved OS.",
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T1 - Improved outcomes for newly diagnosed AL amyloidosis between 2000 and 2014

T2 - Cracking the glass ceiling of early death

AU - Muchtar, Eli

AU - Gertz, Morie

AU - Kumar, Shaji K

AU - Lacy, Martha

AU - Dingli, David M

AU - Buadi, Francis K.

AU - Grogan, Martha

AU - Hayman, Suzanne R.

AU - Kapoor, Prashant

AU - Leung, Nelson

AU - Fonder, Amie

AU - Hobbs, Miriam

AU - Hwa, Yi Lisa

AU - Gonsalves, Wilson

AU - Warsame, Rahma

AU - Kourelis, Taxiarchis

AU - Russell, Stephen J

AU - Lust, John A.

AU - Lin, Yi

AU - Go, Ronald S.

AU - Zeldenrust, Steven

AU - Kyle, Robert A.

AU - Rajkumar, S Vincent

AU - Dispenzieri, Angela

PY - 2017/4/13

Y1 - 2017/4/13

N2 - In light of major advances in immunoglobulin light chain (AL) amyloidosis, we evaluated the trends in presentation, management, and outcome among 1551 newly diagnosed AL amyloidosis patients seen in our institution from 2000 to 2014. As compared with the 2 intervals 2000-2004 and 2005-2009, patients diagnosed in 2010-2014 were less likely to have >2 involved organs. Utilization of autologous stemcell transplant (ASCT)wassimilar across all periods, about one-third of patients, but there was an increase in the use of pre- ASCT bortezomib induction and of unattenuated melphalan conditioning in 2010-2014 compared with earlier periods. Non-ASCT first-line regimen changed with 65% of patients in 2010-2014 received bortezomib-based therapy, 79% of patients in 2005-2009 received melphalan-dexamethasone, and 64% of patients in 2000-2004 received melphalan-prednisone. The rate of better than very good partial response (VGPR) was higher inmore recent periods (66% vs 58% vs 51%;P5.001), a change largely driven by improved VGPR rates in the non-ASCT population. Overall survival (OS) has improved, with inflection points for improvement differing for the ASCT and non-ASCT groups. In the ASCT population, the greatest gainswere after 2010 (4-year OS, 91%comparedwith 73% and 65%). In the non-ASCT group, greatest gains were after 2005 (4-year OS, 38%, 32%, and 16%). Fewer patients died within 6 months of diagnosis in the 2 later periods (24% vs25%vs 37%;P<.001). Overall, outcomes among patients with AL amyloidosis have improved with earlier diagnosis, higher rates of VGPR, lower early mortality, and improved OS.

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