Predictors of early treatment failure following initial therapy for systemic immunoglobulin light-chain amyloidosis

Nidhi Tandon, Surbhi Sidana, S. Vincent Rajkumar, Angela Dispenzieri, Morie A. Gertz, Martha Q. Lacy, Robert A. Kyle, Francis K. Buadi, David Dingli, Suzanne R. Hayman, Amie L. Fonder, Miriam A. Hobbs, Wilson I. Gonsalves, Prashant Kapoor, Yi Lisa Hwa, Nelson Leung, Ronald S. Go, John A. Lust, Stephen J. Russell, Steven R. ZeldenrustShaji K. Kumar

Research output: Contribution to journalArticlepeer-review

Abstract

We analysed factors predicting early treatment failure (ETF), after first-line therapy for light-chain amyloidosis (AL). AL amyloidosis patients seen at Mayo Clinic within 90 days of diagnosis, from 2006 to 2015, excluding those who died within 3 months of initial therapy, were analysed retrospectively. ETF was defined as progression requiring treatment change or death within 12 (ETF12) or 24 (ETF24) months of first-line treatment. Non-ETF included those with a follow-up of more than 12 or 24 months who had progression beyond 12 or 24 months. A total of 724 patients met the study criteria; 244 (33.7%) had ETF12 and 388 (53.6%) had ETF24. Patients with ETF12 were older (64.1 vs. 62.2 years) with higher prevalence of cardiac (81 vs. 64.1%) and multi-organ involvement (67.2 vs. 45.4%) and higher proportion of patients with t(11; 14) (58.5 vs. 44.3%) or in higher Mayo 2012 stage (58.5 vs. 41.1%).The median follow-up was 5.4 years from start of initial therapy. In multivariate analysis, presence of t(11; 14) and non-incorporation of autologous transplant in initial therapy are significant predictors of ETF12 (p =.01and p =.003) and ETF24 (p =.0001 and p =.005) while Mayo stage is predictive of ETF24 (p =.002), but not ETF12.

Original languageEnglish (US)
Pages (from-to)183-188
Number of pages6
JournalAmyloid
Volume24
Issue number3
DOIs
StatePublished - Jul 3 2017

Keywords

  • Predictors
  • amyloidosis
  • early death
  • refractory
  • relapse

ASJC Scopus subject areas

  • Internal Medicine

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