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Treatment and outcomes of patients with light chain amyloidosis who received a second line of therapy post autologous stem cell transplantation
Al Saleh, A. S., Ebraheem, M. S., Sidiqi, M. H., Dispenzieri, A., Muchtar, E., Buadi, F. K., Warsame, R., Lacy, M. Q., Dingli, D., Gonsalves, W. I., et al
Blood cancer journal. 2022;12(4):59
Abstract
We retrospectively reviewed 292 patients who received a second line of therapy post ASCT for their light chain amyloidosis. Most patients (40%) were treated with an alkylator + PI ± dex or PI ± dex followed by an alkylator + 2nd-gen IMiD ± dex or 2nd-gen IMiD ± dex (26%), an alkylator ± steroid or steroid monotherapy (19%), a 2nd-gen IMiD + PI ± dex (6%), an alkylator + thalidomide ± dex (5%), or daratumumab-based therapy (4%). The rate of CR or VGPR was 70% among the daratumumab-based group, 62% in the alkylator + PI ± dex or PI ± dex group, 55% in the alkylator + 2nd-gen IMiD ± dex or 2nd-gen IMiD ± dex group, 47% in the 2nd-gen IMiD + PI ± dex group, 24% in the alkylator ± steroid or steroid monotherapy group, and 18% in the alkylator + thalidomide ± dex group. The median OS was NR for the 2nd-gen IMiD + PI ± dex group and the daratumumab group, 130.4 months in the alkylator + 2nd-gen IMiD ± dex or 2nd-gen IMiD ± dex group, 100 months for the alkylator + PI ± dex or PI ± dex group, 36 months for the alkylator ± steroid or steroid monotherapy group, and 21 months for the alkylator + thalidomide ± dex group (P < 0.0001). The median OS was 100 months in patients who received melphalan 200 mg/m(2) compared to 41 months in the 140 mg/m(2) group (P < 0.0001). In conclusion, patients receiving novel therapy post ASCT and melphalan conditioning dosing at 200 mg/m(2) at diagnosis had better outcomes.
2.
Impact of consolidation therapy post autologous stem cell transplant in patients with light chain amyloidosis
Al Saleh, A. S., Sidiqi, M. H., Sidana, S., Muchtar, E., Dispenzieri, A., Dingli, D., Lacy, M. Q., Warsame, R. M., Gonsalves, W. I., Kourelis, T. V., et al
American journal of hematology. 2019
Abstract
The role of consolidation post autologous stem cell transplant in light chain amyloidosis is not well defined. We retrospectively identified patients who had light chain amyloidosis and underwent autologous stem cell transplant at the Mayo Clinic. Consolidation was defined as any treatment given after the day 100 evaluation post transplant to maintain or deepen the response. We identified 471 patients, of whom 72 (15%) received consolidation. Patient receiving consolidation had more advanced disease (Mayo 2012 stage ≥II in 67% vs. 52%, P=0.02) and had lower day 100 response rates (very good partial response or better: 35% vs.84%, P<0.0001). After consolidation, rates of very good partial response improved from 24% to 28% and rates of complete response improved from 11% to 40%. Patients with less than very good partial response who received consolidation had better progression free survival (median of 22.4 vs. 8.8 months, P <0.0001) and the benefit was greater in those who deepened their response (median of 41 vs.8.8 months, P<0.0001). In patients with less than very good partial response, there was a trend for better overall survival in patients with less than very good partial response who responded to consolidation (median of 125.8 vs. 74.4 months, P=0.07). In patients who achieved very good partial response or better at day 100 post autologous stem cell transplant, consolidation did not improve progression free or overall survival. Consolidation after autologous stem cell transplant for light chain amyloidosis improves progression fee survival for patients who achieve less than very good partial response. This article is protected by copyright. All rights reserved.
3.
Long-term event-free and overall survival after risk-adapted melphalan and SCT for systemic light chain amyloidosis
Landau, H., Smith, M., Landry, C., Chou, J. F., Devlin, S. M., Hassoun, H., Bello, C., Giralt, S., Comenzo, R. L.
Leukemia. 2017;31(1):136-142
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Abstract
Stem cell transplantation (SCT), an effective therapy for amyloid light chain (AL) amyloidosis patients, is associated with low treatment-related mortality (TRM) with appropriate patient selection and risk-adapted dosing of melphalan (RA-SCT). Consolidation after SCT increases hematologic complete response (CR) rates and may improve overall survival (OS) for patients with