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

Nidhi Tandon, Surbhi Sidana, S Vincent Rajkumar, Angela Dispenzieri, Morie Gertz, Martha Lacy, Robert A. Kyle, Francis K. Buadi, David M Dingli, Suzanne R. Hayman, Amie L. Fonder, Miriam A. Hobbs, Wilson 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 journalArticle

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)1-6
Number of pages6
JournalAmyloid
DOIs
StateAccepted/In press - Jul 11 2017

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Keywords

  • amyloidosis
  • early death
  • Predictors
  • refractory
  • relapse

ASJC Scopus subject areas

  • Internal Medicine

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