Interphase fluorescence in situ hybridization in untreated AL amyloidosis has an independent prognostic impact by abnormality type and treatment category

E. Muchtar, Angela Dispenzieri, Shaji K Kumar, R. P. Ketterling, David M Dingli, Martha Lacy, F. K. Buadi, S. R. Hayman, Prashant Kapoor, N. Leung, R. Chakraborty, Wilson Gonsalves, R. Warsame, Taxiarchis Kourelis, Stephen J Russell, J. A. Lust, Yi Lin, R. S. Go, S. Zeldenrust, R. A. KyleS Vincent Rajkumar, Morie Gertz

Research output: Contribution to journalArticlepeer-review

48 Scopus citations

Abstract

The significance of interphase fluorescence in situ hybridization (iFISH) by regimen type was assessed in 692 immunoglobulin light-chain (AL) amyloidosis patients with iFISH at diagnosis. First-line treatment was categorized as stem cell transplant and three non-transplant regimens. The most common abnormality was t(11;14) (49% of patients) followed by monosomy 13/del(13q) (36%) and trisomies (26%). A lower rate of very good partial response (VGPR) or better was observed in patients with t(11;14) treated with bortezomib-based (52% vs 77%; P=0.004) and IMiD-based regimens (13% vs 54%; P=0.04) compared with those lacking t(11;14). This corresponded to an inferior overall survival (OS) in t(11;14)-positive bortezomib-treated (median 15 vs 27 months; P=0.05) and IMiD-treated patients (median 12 vs 32 months; P=0.05). The inferior OS associated with t(11;14) bortezomib-treated patients was restricted to patients with favorable disease. Trisomies were associated with a shorter OS (median 29 vs 69 months; P=0.001), reaching statistical significance only for melphalan (median 15 vs 32 months; P=0.02). Multivariate analysis confirmed an independent survival impact for trisomies in the entire cohort and for t(11;14) among bortezomib-treated patients. iFISH is prognostic in untreated AL amyloidosis and may influence treatment selection. Patients with t(11;14) should be considered for ASCT or standard-dose melphalan at diagnosis because the survival disadvantage may be abrogated.Leukemia advance online publication, advance online publication, 16 December 2016; doi:10.1038/leu.2016.369.

Original languageEnglish (US)
JournalLeukemia
DOIs
StateAccepted/In press - Dec 16 2016

ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine

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