title: Successful treatment of AL amyloidosis with high-dose melphalan and autologous stem cell transplantation in patients over age 65.
abstract: 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.
authors.affiliation: Section of Hematology-Oncology, Boston University Medical Center, 650 Albany St, Boston, MA 02118, USA. dseldin@bu.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Seldin
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Anderson
authors.forename: Martha
authors.initials: M
authors.lastname: Skinner
authors.forename: Karim
authors.initials: K
authors.lastname: Malek
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Wright
authors.forename: Karen
authors.initials: K
authors.lastname: Quillen
authors.forename: Kathleen
authors.initials: K
authors.lastname: Finn
authors.forename: Betul
authors.initials: B
authors.lastname: Oran
authors.forename: Vaishali
authors.initials: V
authors.lastname: Sanchorawala
mesh_terms: 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
chemical_list: D018906:Antineoplastic Agents, Alkylating; D007147:Immunoglobulin Light Chains; D008558:Melphalan