title: Cardiac transplantation followed by dose-intensive melphalan and autologous stem-cell transplantation for light chain amyloidosis and heart failure.
abstract: BACKGROUND
  Patients with light chain (AL) amyloidosis who present with severe heart failure due to cardiac involvement rarely survive more than 6 months. Survival after cardiac transplantation is markedly reduced due to the progression of amyloidosis. Autologous stem-cell transplantation (ASCT) has become a common therapy for AL amyloidosis, but there is an exceedingly high treatment-related mortality in patients with heart failure.
  
  
  METHODS
  We developed a treatment strategy of cardiac transplant followed by ASCT. Twenty-six patients were evaluated, and of 18 eligible patients, nine patients underwent cardiac transplantation. Eight of these patients subsequently received an ASCT.
  
  
  RESULTS
  Six of seven evaluable patients achieved a complete hematologic remission, and one achieved a partial remission. At a median follow-up of 56 months from cardiac transplant, five of seven patients are alive without recurrent amyloidosis. Their survival is comparable with 17,389 patients who received heart transplants for nonamyloid heart disease: 64% in nonamyloid vs. 60% in amyloid patients at 7 years (P=0.83). Seven of eight transplanted patients have had no evidence of amyloid in their cardiac allograft.
  
  
  CONCLUSIONS
  This demonstrates that cardiac transplantation followed by ASCT is feasible in selected patients with AL amyloidosis and heart failure, and that such a strategy may lead to improved overall survival.
authors: Massachusetts General Hospital, Boston, MA, USA.
authors: Bimalangshu R
authors: BR
authors: Dey
authors: Stephen S
authors: SS
authors: Chung
authors: Thomas R
authors: TR
authors: Spitzer
authors: Hui
authors: H
authors: Zheng
authors: Thomas E
authors: TE
authors: Macgillivray
authors: David C
authors: DC
authors: Seldin
authors: Steven
authors: S
authors: McAfee
authors: Karen
authors: K
authors: Ballen
authors: Eyal
authors: E
authors: Attar
authors: Thomas
authors: T
authors: Wang
authors: Jordan
authors: J
authors: Shin
authors: Christopher
authors: C
authors: Newton-Cheh
authors: Stephanie
authors: S
authors: Moore
authors: Vaishali
authors: V
authors: Sanchorawala
authors: Martha
authors: M
authors: Skinner
authors: Joren C
authors: JC
authors: Madsen
authors: Marc J
authors: MJ
authors: Semigran
mesh_terms: D000328:Adult; D000368:Aged; D000409:Alanine / Q000097:blood; D000686:Amyloidosis / Q000401:mortality / Q000601:surgery*; D001219:Aspartate Aminotransferases / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D033581:Stem Cell Transplantation / Q000379:methods*; D013318:Stroke Volume; D014182:Transplantation, Autologous
chemical_list: D002316:Cardiotonic Agents; D001219:Aspartate Aminotransferases; D000409:Alanine; D008558:Melphalan