Long-term risk of myelodysplasia in melphalan-treated patients with immunoglobulin light-chain amyloidosis

Survival of patients with plasma cell disorders has increased. However, the expanding use of melphalan in patients with longer survival suggests that myelodysplasia may become increasingly important. The objective of this study was to determine the risk of myelodysplasia after treatment with melphalan for patients with amyloidosis. We reviewed the long-term follow-up data (more than 12 years) from 101 patients with immunoglobulin light-chain amyloidosis. We identified 10 patients with myelodysplasia or acute nonlymphocytic leukemia that directly caused death for 8 and transfusion dependency for 2. Two of the 10 patients did not have development of myelodysplasia until 144 months after first exposure to alkylating agents. The actuarial risk of myelodysplasia development at ten years was 18%. As the survival of patients with plasma cell disorders improves, myelodysplasia may be a more common cause of morbidity and mortality for this group.