Prognostic restaging at the time of second-line therapy in patients with AL amyloidosis

Yi L. Hwa, Morie Gertz, Shaji K Kumar, Martha Lacy, Francis K. Buadi, David M Dingli, Prashant Kapoor, Steve R. Zeldenrust, Nelson Leung, Susanne R. Hayman, Wilson Gonsalves, Taxiarchis Kourelis, Rahma Warsame, Ronald S. Go, Eli Muchtar, Miriam A. Hobbs, Amie L. Fonder, Stephen J Russell, Robert A. Kyle, S Vincent RajkumarAngela Dispenzieri

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Abstract

It is well known that staging of patients with AL amyloidosis at diagnosis predicts for survival, but there is a paucity of literature delineating the prognostic value of these systems at relapse. We evaluated the prognostic value of AL staging among 413 patients initiated with second-line therapy between 2000 and 2015. Both the Revised Mayo 2012 and the European revision of Mayo 2004 staging systems were used. The median time from initial treatment to second-line therapy was 11.7 months. The first-line therapy was autologous stem cell transplant (ASCT) in 179 (43%) patients and non-ASCT therapies in 234 patients. Median survival from the institution of second-line therapy was 61 months. Both the Mayo 2004 and 2012 staging systems were of prognostic benefit at second-line therapy with respective risk ratios of 2.78 (95% CI: 2.15, 3.58) and 3.03 (95% CI: 2.33, 3.93) for patients with > stage 2 disease. On multivariate analysis, the predictive value of staging at second-line therapy was independent of stage at diagnosis and prior ASCT as first-line therapy. This study indicates that the Mayo staging systems work well at second-line therapy. Consequently, it is suitable for the stratification of patients in trials for relapsed, refractory AL amyloidosis.

Original languageEnglish (US)
JournalLeukemia
DOIs
StatePublished - Jan 1 2019

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ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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