Successful treatment of AL amyloidosis with high-dose melphalan and autologous stem cell transplantation in patients over age 65.
Recently, protocols using high-dose melphalan chemotherapy and autologous peripheral blood stem cell transplantation (HDM/SCT) have been developed for the treatment of patients with immunoglobulin light chain (AL) amyloidosis. Although peritransplantation mortality is greater than for other hematologic diseases, treatment leads to durable hematologic complete responses, improvements in organ function and quality of life, and extended survival in a substantial proportion of patients. To determine whether this treatment can be applied to older patients, we have analyzed HDM/SCT treatment outcomes for 65 patients (aged 65 years or older) with AL amyloidosis compared with outcomes for 280 younger patients. For patients over age 65 years who meet the same eligibility criteria as younger patients, toxicity, hematologic remission rate, and survival were not significantly different from those observed in younger patients, indicating that older patients should not be excluded a priori from consideration for HDM/SCT treatment.
Seldin
David C
DC
Section of Hematology-Oncology, Boston University Medical Center, 650 Albany St, Boston, MA 02118, USA. dseldin@bu.edu
Anderson
Jennifer J
JJ
Skinner
Martha
M
Malek
Karim
K
Wright
Daniel G
DG
Quillen
Karen
K
Finn
Kathleen
K
Oran
Betul
B
Sanchorawala
Vaishali
V
D000328:Adult; D000368:Aged; D000375:Aging; D000686:Amyloidosis / Q000401:mortality / Q000628:therapy*; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains; D008297:Male; D008558:Melphalan / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D011788:Quality of Life; D020127:Recovery of Function; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D014182:Transplantation, Autologous
D018906:Antineoplastic Agents, Alkylating; D007147:Immunoglobulin Light Chains; D008558:Melphalan