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

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98 Citations (Scopus)

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 2013

Fingerprint

Stem Cell Transplantation
Amyloidosis
Patient Selection
Troponin T
Mortality
Brain Natriuretic Peptide
Transplants
Therapeutics
Serum
Dialysis
Transplantation
Guidelines
Biopsy
Light
Transplant Recipients

Keywords

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

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

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title = "Refinement in patient selection to reduce treatment-related mortality from autologous stem cell transplantation in amyloidosis",
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.",
keywords = "amyloidosis, diastolic heart failure, multiple myeloma, nephrotic syndrome, SCT",
author = "Morie Gertz and Martha Lacy and Angela Dispenzieri and Kumar, {Shaji K} and Dingli, {David M} and N. Leung and William Hogan and Buadi, {F. K.} and Hayman, {S. R.}",
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AU - Gertz, Morie

AU - Lacy, Martha

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AU - Kumar, Shaji K

AU - Dingli, David M

AU - Leung, N.

AU - Hogan, William

AU - Buadi, F. K.

AU - Hayman, S. R.

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N2 - 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.

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