Troponin T level as an exclusion criterion for stem cell transplantation in light-chain amyloidosis.
The efficacy of stem cell transplantation in amyloidosis largely is determined by treatment-related mortality rates (range, 11-25%). Appropriate patient selection is essential to avoid this high mortality rate. Among 271 patients undergoing stem cell transplantation, troponin T was a powerful predictor of treatment-related mortality. Patients with troponin T levels of 0.06 microg/L or higher had a day-100 all-cause mortality rate of 28%. Patients with troponin T levels less than 0.06 microg/L had a day-100 all-cause mortality rate of 7% (P < 0.001). Troponin T levels should be measured in all patients before transplantation. Those with troponin T levels exceeding 0.06 microg/L should be considered for less toxic therapies until the clinically optimal use of stem cell transplantation is better defined by randomized clinical trials.
Gertz
Morie
M
Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. gertz.morie@mayo.edu
Lacy
Martha
M
Dispenzieri
Angela
A
Hayman
Suzanne
S
Kumar
Shaji
S
Buadi
Francis
F
Leung
Nelson
N
Litzow
Mark
M
D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D015415:Biomarkers; D002423:Cause of Death; D004562:Electrocardiography; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D007147:Immunoglobulin Light Chains; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D007147:Immunoglobulin Light Chains; D020107:Troponin T