Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation

Angela Dispenzieri, Morie Gertz, Robert A. Kyle, Martha Lacy, Mary F. Burritt, Terry M Therneau, Joseph P. McConnell, Mark R Litzow, Dennis A. Gastineau, Ayalew Tefferi, David J. Inwards, Ivana Micallef, Stephen Maxted Ansell, Luis F. Porrata, Michelle A. Elliott, William Hogan, S Vincent Rajkumar, Rafael Fonseca, Philip R. Greipp, Thomas Elmer Witzig & 6 others John A. Lust, Steven R. Zeldenrust, Denise S. Snow, Susan R. Hayman, Christopher G A McGregor, Allan S Jaffe

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Abstract

Primary systemic amyloidosis (AL) is a fatal plasma cell disorder. Pilot data suggest survival is better in patients undergoing peripheral blood stem cell transplantation (PBSCT), but the selection process makes the apparent benefit suspect. We have reported that circulating cardiac biomarkers are the best predictors of survival outside of the transplantation setting. We now test whether cardiac troponins (cTnT and cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are prognostic in transplant recipients. In 98 patients with AL undergoing PBSCT, serum cardiac biomarkers were measured (cTnT, 98 patients; cTnI, 65 patients; and NT-proBNP, 63 patients). Elevated levels of cTnT, cTnI, and NT-proBNP were present in 14%, 43%, and 48% of patients, respectively. At 20 months median follow-up, median survival has not been reached for patients with values below the thresholds; in patients with values above the thresholds, median survival is 26.1 months, 66.1 months, and 66.1 months, respectively. Our previously reported risk systems incorporating these markers were also prognostic, notably the cTnT/NT-proBNP staging. Using this system, 49%, 38%, and 13% of patients were in stage I, stage II, and stage III, respectively. Determining levels of circulating biomarkers may be the most powerful tool for staging patients with AL undergoing PBSCT.

Original languageEnglish (US)
Pages (from-to)1881-1887
Number of pages7
JournalBlood
Volume104
Issue number6
DOIs
StatePublished - Sep 15 2004

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Peripheral Blood Stem Cell Transplantation
Troponin
Brain Natriuretic Peptide
Stem cells
Biomarkers
Blood
Survival
Transplants
Amyloidosis
Plasmas
Primary amyloidosis
Plasma Cells
Transplantation

ASJC Scopus subject areas

  • Hematology

Cite this

Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. / Dispenzieri, Angela; Gertz, Morie; Kyle, Robert A.; Lacy, Martha; Burritt, Mary F.; Therneau, Terry M; McConnell, Joseph P.; Litzow, Mark R; Gastineau, Dennis A.; Tefferi, Ayalew; Inwards, David J.; Micallef, Ivana; Ansell, Stephen Maxted; Porrata, Luis F.; Elliott, Michelle A.; Hogan, William; Rajkumar, S Vincent; Fonseca, Rafael; Greipp, Philip R.; Witzig, Thomas Elmer; Lust, John A.; Zeldenrust, Steven R.; Snow, Denise S.; Hayman, Susan R.; McGregor, Christopher G A; Jaffe, Allan S.

In: Blood, Vol. 104, No. 6, 15.09.2004, p. 1881-1887.

Research output: Contribution to journalArticle

Dispenzieri, Angela ; Gertz, Morie ; Kyle, Robert A. ; Lacy, Martha ; Burritt, Mary F. ; Therneau, Terry M ; McConnell, Joseph P. ; Litzow, Mark R ; Gastineau, Dennis A. ; Tefferi, Ayalew ; Inwards, David J. ; Micallef, Ivana ; Ansell, Stephen Maxted ; Porrata, Luis F. ; Elliott, Michelle A. ; Hogan, William ; Rajkumar, S Vincent ; Fonseca, Rafael ; Greipp, Philip R. ; Witzig, Thomas Elmer ; Lust, John A. ; Zeldenrust, Steven R. ; Snow, Denise S. ; Hayman, Susan R. ; McGregor, Christopher G A ; Jaffe, Allan S. / Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. In: Blood. 2004 ; Vol. 104, No. 6. pp. 1881-1887.
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abstract = "Primary systemic amyloidosis (AL) is a fatal plasma cell disorder. Pilot data suggest survival is better in patients undergoing peripheral blood stem cell transplantation (PBSCT), but the selection process makes the apparent benefit suspect. We have reported that circulating cardiac biomarkers are the best predictors of survival outside of the transplantation setting. We now test whether cardiac troponins (cTnT and cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are prognostic in transplant recipients. In 98 patients with AL undergoing PBSCT, serum cardiac biomarkers were measured (cTnT, 98 patients; cTnI, 65 patients; and NT-proBNP, 63 patients). Elevated levels of cTnT, cTnI, and NT-proBNP were present in 14{\%}, 43{\%}, and 48{\%} of patients, respectively. At 20 months median follow-up, median survival has not been reached for patients with values below the thresholds; in patients with values above the thresholds, median survival is 26.1 months, 66.1 months, and 66.1 months, respectively. Our previously reported risk systems incorporating these markers were also prognostic, notably the cTnT/NT-proBNP staging. Using this system, 49{\%}, 38{\%}, and 13{\%} of patients were in stage I, stage II, and stage III, respectively. Determining levels of circulating biomarkers may be the most powerful tool for staging patients with AL undergoing PBSCT.",
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T1 - Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation

AU - Dispenzieri, Angela

AU - Gertz, Morie

AU - Kyle, Robert A.

AU - Lacy, Martha

AU - Burritt, Mary F.

AU - Therneau, Terry M

AU - McConnell, Joseph P.

AU - Litzow, Mark R

AU - Gastineau, Dennis A.

AU - Tefferi, Ayalew

AU - Inwards, David J.

AU - Micallef, Ivana

AU - Ansell, Stephen Maxted

AU - Porrata, Luis F.

AU - Elliott, Michelle A.

AU - Hogan, William

AU - Rajkumar, S Vincent

AU - Fonseca, Rafael

AU - Greipp, Philip R.

AU - Witzig, Thomas Elmer

AU - Lust, John A.

AU - Zeldenrust, Steven R.

AU - Snow, Denise S.

AU - Hayman, Susan R.

AU - McGregor, Christopher G A

AU - Jaffe, Allan S

PY - 2004/9/15

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N2 - Primary systemic amyloidosis (AL) is a fatal plasma cell disorder. Pilot data suggest survival is better in patients undergoing peripheral blood stem cell transplantation (PBSCT), but the selection process makes the apparent benefit suspect. We have reported that circulating cardiac biomarkers are the best predictors of survival outside of the transplantation setting. We now test whether cardiac troponins (cTnT and cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are prognostic in transplant recipients. In 98 patients with AL undergoing PBSCT, serum cardiac biomarkers were measured (cTnT, 98 patients; cTnI, 65 patients; and NT-proBNP, 63 patients). Elevated levels of cTnT, cTnI, and NT-proBNP were present in 14%, 43%, and 48% of patients, respectively. At 20 months median follow-up, median survival has not been reached for patients with values below the thresholds; in patients with values above the thresholds, median survival is 26.1 months, 66.1 months, and 66.1 months, respectively. Our previously reported risk systems incorporating these markers were also prognostic, notably the cTnT/NT-proBNP staging. Using this system, 49%, 38%, and 13% of patients were in stage I, stage II, and stage III, respectively. Determining levels of circulating biomarkers may be the most powerful tool for staging patients with AL undergoing PBSCT.

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