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.
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.
Dispenzieri
Angela
A
Division of Hematology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. dispenzieri.angela@mayo.edu
Gertz
Morie A
MA
Kyle
Robert A
RA
Lacy
Martha Q
MQ
Burritt
Mary F
MF
Therneau
Terry M
TM
McConnell
Joseph P
JP
Litzow
Mark R
MR
Gastineau
Dennis A
DA
Tefferi
Ayalew
A
Inwards
David J
DJ
Micallef
Ivana N
IN
Ansell
Stephen M
SM
Porrata
Luis F
LF
Elliott
Michelle A
MA
Hogan
William J
WJ
Rajkumar
S Vincent
SV
Fonseca
Rafael
R
Greipp
Philip R
PR
Witzig
Thomas E
TE
Lust
John A
JA
Zeldenrust
Steven R
SR
Snow
Denise S
DS
Hayman
Susan R
SR
McGregor
Christopher G A
CG
Jaffe
Allan S
AS
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*
D015415:Biomarkers; D014336:Troponin; D020097:Natriuretic Peptide, Brain