Revisiting conditioning dose in newly diagnosed light chain amyloidosis undergoing frontline autologous stem cell transplant: impact on response and survival

N. Tandon, E. Muchtar, S. Sidana, Angela Dispenzieri, Martha Lacy, David M Dingli, F. K. Buadi, S. R. Hayman, R. Chakraborty, William Hogan, Wilson Gonsalves, R. Warsame, Taxiarchis Kourelis, N. Leung, Prashant Kapoor, Shaji K Kumar, Morie Gertz

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Autologous stem cell transplantation (ASCT) is an important treatment modality in light chain (AL) amyloidosis. Use of reduced-dose melphalan conditioning is common, given the associated organ and functional decline. The impact of full-intensity melphalan conditioning (n=314) was compared to reduced-dose conditioning (n=143). Patients in the full-intensity group were younger, with better performance status, fewer involved organs, lower tumor burden and lower Mayo stage. Full-dose conditioning was associated with higher rate of very good partial response or better (79% vs 62%; P<0.001), complete response rate (53% vs 37%; P=0.003) and organ response rate (74% vs 59%; P=0.002) as compared to reduced-dose conditioning. PFS was superior in the full-intensity group compared to the reduced-dose group (4-year PFS 55% vs 31%; P<0.001) as well as a longer overall survival (OS) 4-year OS (86% vs 54%; P<0.001). In addition, the OS and PFS were significantly lower in the reduced-dose group compared to the full-intensity group in Mayo stage III/IV as well as stage I/II. A multivariate analysis confirmed an independent impact for conditioning dose on PFS/OS. This study calls for re-assessment of the use of reduced-dose conditioning in ASCT for AL amyloidosis.Bone Marrow Transplantation advance online publication, 10 April 2017; doi:10.1038/bmt.2017.68.

Original languageEnglish (US)
JournalBone Marrow Transplantation
DOIs
StateAccepted/In press - Apr 10 2017

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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