Refinement in patient selection to reduce treatment-related mortality from autologous stem cell transplantation in amyloidosis

M. A. Gertz, M. Q. Lacy, A. Dispenzieri, S. K. Kumar, D. Dingli, N. Leung, W. J. Hogan, F. K. Buadi, S. R. Hayman

Research output: Contribution to journalReview article

106 Scopus citations

Abstract

This study sought to develop selection guidelines to determine the eligibility for SCT of patients with light-chain amyloidosis. Patients with biopsy-confirmed lightchain amyloidosis who underwent SCT between 8 March 1996 and 31 December 2011 were reviewed in two cohorts by date of transplantation: between 8 March 1996 and 30 June 2009 (n=410) and between 1 July 2009 and 31 December 2011 (n=89). Also evaluated were patients who died before post-transplant day 100 to determine the features predictive of early death. After 1 July 2009, fewer transplant recipients had Mayo stage III cardiac involvement. Mortality before post-transplant day 100 was 10.5% (43/410) in the earlier group and 1.1% (1/89) in the later group. In the earlier group, one-quarter of transplant recipients with N-terminal pro-brain natriuretic peptide (NT-proBNP) >5000 pg/mL died by 10.3 months. When serum troponin T was >0.06 ng/mL, 25% died at 3.7 months. The Mayo staging system is predictive for OS but not useful for selecting transplant recipients. Patients with serum troponin T >0.06 ng/mL or NT-proBNP >5000 pg/mL (not on dialysis) should not be considered candidates for SCT because of early mortality.

Original languageEnglish (US)
Pages (from-to)557-561
Number of pages5
JournalBone Marrow Transplantation
Volume48
Issue number4
DOIs
StatePublished - Apr 1 2013

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Keywords

  • SCT
  • amyloidosis
  • diastolic heart failure
  • multiple myeloma
  • nephrotic syndrome

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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