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. Zeldenrust & 1 others Shaji 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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Immunoglobulin Light Chains
Amyloidosis
Treatment Failure
Therapeutics
Autografts
Multivariate Analysis
Light

Keywords

  • amyloidosis
  • early death
  • Predictors
  • refractory
  • relapse

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Predictors of early treatment failure following initial therapy for systemic immunoglobulin light-chain amyloidosis. / Tandon, Nidhi; Sidana, Surbhi; Rajkumar, S Vincent; Dispenzieri, Angela; Gertz, Morie; Lacy, Martha; Kyle, Robert A.; Buadi, Francis K.; Dingli, David M; Hayman, Suzanne R.; Fonder, Amie L.; Hobbs, Miriam A.; Gonsalves, Wilson; Kapoor, Prashant; Hwa, Yi Lisa; Leung, Nelson; Go, Ronald S.; Lust, John A.; Russell, Stephen J; Zeldenrust, Steven R.; Kumar, Shaji K.

In: Amyloid, 11.07.2017, p. 1-6.

Research output: Contribution to journalArticle

Tandon, Nidhi ; Sidana, Surbhi ; Rajkumar, S Vincent ; Dispenzieri, Angela ; Gertz, Morie ; Lacy, Martha ; Kyle, Robert A. ; Buadi, Francis K. ; Dingli, David M ; Hayman, Suzanne R. ; Fonder, Amie L. ; Hobbs, Miriam A. ; Gonsalves, Wilson ; Kapoor, Prashant ; Hwa, Yi Lisa ; Leung, Nelson ; Go, Ronald S. ; Lust, John A. ; Russell, Stephen J ; Zeldenrust, Steven R. ; Kumar, Shaji K. / Predictors of early treatment failure following initial therapy for systemic immunoglobulin light-chain amyloidosis. In: Amyloid. 2017 ; pp. 1-6.
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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.",
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AU - Tandon, Nidhi

AU - Sidana, Surbhi

AU - Rajkumar, S Vincent

AU - Dispenzieri, Angela

AU - Gertz, Morie

AU - Lacy, Martha

AU - Kyle, Robert A.

AU - Buadi, Francis K.

AU - Dingli, David M

AU - Hayman, Suzanne R.

AU - Fonder, Amie L.

AU - Hobbs, Miriam A.

AU - Gonsalves, Wilson

AU - Kapoor, Prashant

AU - Hwa, Yi Lisa

AU - Leung, Nelson

AU - Go, Ronald S.

AU - Lust, John A.

AU - Russell, Stephen J

AU - Zeldenrust, Steven R.

AU - Kumar, Shaji K

PY - 2017/7/11

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N2 - 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.

AB - 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.

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