title: Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation.
abstract: Primary systemic amyloidosis (AL) is a fatal plasma cell disorder. Pilot data suggest survival is better in patients undergoing peripheral blood stem cell transplantation (PBSCT), but the selection process makes the apparent benefit suspect. We have reported that circulating cardiac biomarkers are the best predictors of survival outside of the transplantation setting. We now test whether cardiac troponins (cTnT and cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are prognostic in transplant recipients. In 98 patients with AL undergoing PBSCT, serum cardiac biomarkers were measured (cTnT, 98 patients; cTnI, 65 patients; and NT-proBNP, 63 patients). Elevated levels of cTnT, cTnI, and NT-proBNP were present in 14%, 43%, and 48% of patients, respectively. At 20 months median follow-up, median survival has not been reached for patients with values below the thresholds; in patients with values above the thresholds, median survival is 26.1 months, 66.1 months, and 66.1 months, respectively. Our previously reported risk systems incorporating these markers were also prognostic, notably the cTnT/NT-proBNP staging. Using this system, 49%, 38%, and 13% of patients were in stage I, stage II, and stage III, respectively. Determining levels of circulating biomarkers may be the most powerful tool for staging patients with AL undergoing PBSCT.
authors.affiliation: Division of Hematology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. dispenzieri.angela@mayo.edu
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: Mary F
authors.initials: MF
authors.lastname: Burritt
authors.forename: Terry M
authors.initials: TM
authors.lastname: Therneau
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McConnell
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Gastineau
authors.forename: Ayalew
authors.initials: A
authors.lastname: Tefferi
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Ivana N
authors.initials: IN
authors.lastname: Micallef
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Ansell
authors.forename: Luis F
authors.initials: LF
authors.lastname: Porrata
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Elliott
authors.forename: William J
authors.initials: WJ
authors.lastname: Hogan
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
authors.forename: Rafael
authors.initials: R
authors.lastname: Fonseca
authors.forename: Philip R
authors.initials: PR
authors.lastname: Greipp
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.forename: John A
authors.initials: JA
authors.lastname: Lust
authors.forename: Steven R
authors.initials: SR
authors.lastname: Zeldenrust
authors.forename: Denise S
authors.initials: DS
authors.lastname: Snow
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hayman
authors.forename: Christopher G A
authors.initials: CG
authors.lastname: McGregor
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000737:chemistry*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D036102:Peripheral Blood Stem Cell Transplantation; D011336:Probability; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin; D020097:Natriuretic Peptide, Brain