title: Short and long-term outcome of treatment with high-dose melphalan and stem cell transplantation for multiple myeloma-associated AL amyloidosis.
abstract: High-dose melphalan chemotherapy and autologous peripheral blood stem cell transplantation (HDM/SCT) has been shown to result in a durable hematologic response and prolonged overall survival in systemic amyloid light-chain (AL) amyloidosis as well as multiple myeloma. However, little is known about the myeloma associated with AL amyloidosis (MM/AL). In this retrospective study, we evaluated 87 patients with MM/AL from 1994 to 2007. Sixteen of these patients underwent HDM/SCT at Boston University Medical Center. Three patients (19%) died from treatment-related mortality. The overall median survival for all 87 patients was 22 months by Kaplan-Meier estimates. However, this was improved to 54.5 months for those who received HDM/SCT compared to 21 months for those who did not receive HDM/SCT. A hematologic complete response was achieved by 25% (4/16) of patients at 6 months after HDM/SCT. Hematologic relapses occurred in 60% of patients at a median of 1 year after HDM/SCT. In conclusion, HDM/SCT can prolong overall survival in patients with MM/AL who are eligible to receive it.
authors.affiliation: Amyloid Treatment and Research Program, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Saulius
authors.initials: S
authors.lastname: Girnius
authors.forename: David C
authors.initials: DC
authors.lastname: Seldin
authors.forename: Martha
authors.initials: M
authors.lastname: Skinner
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Finn
authors.forename: Karen
authors.initials: K
authors.lastname: Quillen
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.forename: Vaishali
authors.initials: V
authors.lastname: Sanchorawala
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000682:Amyloid / Q000378:metabolism; D000686:Amyloidosis / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D021122:Protein Subunits / Q000378:metabolism; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000682:Amyloid; D018906:Antineoplastic Agents, Alkylating; D021122:Protein Subunits; D008558:Melphalan