Prognostic restaging after treatment initiation in patients with AL amyloidosis

Nadine Abdallah, Angela Dispenzieri, Eli Muchtar, Francis K. Buadi, Prashant Kapoor, Martha Q. Lacy, Yi L. Hwa, Amie Fonder, Miriam A. Hobbs, Suzanne R. Hayman, Nelson Leung, David Dingli, John A. Lust, Ronald S. Go, Yi Lin, Wilson I. Gonsalves, Taxiarchis Kourelis, Rahma Warsame, Robert A. Kyle, S. Vincent RajkumarMorie A. Gertz, Shaji K. Kumar

Research output: Contribution to journalArticlepeer-review

Abstract

The utility of systemic light chain (AL) amyloidosis staging systems has been validated for newly diagnosed patients, but their role in restaging after treatment has not been explored. We designed this study to evaluate whether the currently used systems are of prognostic value at 3 and 6 months of starting first-line treatment, and whether stage migration from diagnosis impacts survival. This is a retrospective study including Mayo Clinic patients with AL amyloidosis diagnosed between 1 January 2006 and 30 June 2019; 536 and 204 patients had restaging data for at least 1 system at 3 and 6 months, respectively. Using modified Mayo 2004 staging at 3 months, median overall survival (OSs) were 11.8, 10.8, 4.6, and 1.1 years for stage I, II, IIIa, and IIIb, respectively. Using Mayo 2012, median OSs were 11.8, 9.0, 5.2, and 0.8 years for stage I, II, III, and IV, respectively. Using modified Mayo 2004 staging at 6 months, median OSs were not reached (NR), NR, 5.4, and 0.9 years for stage I, II, IIIa, and IIIb, respectively. Using Mayo 2012, OSs were NR, NR, 4.6, and 0.9 years for stage I, II, III, and IV, respectively. Worsening stage at 3 or 6 months was associated with worse survival than retaining baseline stage. In conclusion, the current staging systems can be used for restaging at 3 and 6 months from treatment initiation. Migration to higher stage predicts poor prognosis.

Original languageEnglish (US)
Pages (from-to)1029-1036
Number of pages8
JournalBlood Advances
Volume5
Issue number4
DOIs
StatePublished - Feb 23 2021

ASJC Scopus subject areas

  • Hematology

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