Improved Outcomes Shown Post Autotransplantation in Amyloidosis
Post hematopoietic cell transplantation survival in patients with light-chain amyloidosis has improved.
Post hematopoietic cell transplantation survival in patients with light-chain amyloidosis has improved, with a significant reduction in early post-transplantation mortality and excellent 5-year survival, according to an article published online ahead of print in the Journal of Clinical Oncology.1
Investigators from the Center for International Blood and Marrow Transplant Research conducted a study between 1995 and 2012 that included 1,536 patients with amyloidosis identified through the Center for International Blood and Marrow Transplant Research database.
Early mortality and overall survival were analyzed within three time cohorts: 1995 to 2000 (n = 140), 2001 to 2006 (n = 596), and 2007 to 2012 (n = 800).
Results showed that thirty-day mortality progressively declined from 11% in 1995 to 2000 to 5% in 2001 to 2006 to 3% in 2007 to 2012. One hundred-day mortality declined from 20% to 11% to 5%, respectively. Five-year overall survival increased from 55% to 61% and 77%, respectively.
Centers that performed more than four transplantations per year had superior survival outcomes. Multivariate analysis showed cardiac amyloidosis was linked with high early mortality.
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Patients who received autotransplantation between 2007 and 2012 and who received higher dosages of melphalan showed a lower risk of relapse. Worsened overall survival was affiliated with a Karnofsky score less than 80 and creatinine levels 2 mg/m2.
The authors concluded that the risk-benefit ratio for autotransplantation has changed, and randomized comparison with nontransplantation approaches is warranted.
- D'Souza, Dispenzieri A, Wirk B, et al. Improved outcomes after autologous hematopoietic cell transplantation for light chain amyloudosis: a Center for International Blood and Marrow Transplant Research study. [published online ahead of print September 14, 2015]. J Clin Oncol. doi: 10.1200/JCO.2015.62.4015.