title: Cyclophosphamide-bortezomib-dexamethasone (CyBorD) produces rapid and complete hematologic response in patients with AL amyloidosis.
abstract: Cyclophosphamide, bortezomib, and dexamethasone (CyBorD) is highly effective in multiple myeloma. We treated patients with light chain amyloidosis (AL) before stem cell transplantation (ASCT), instead of ASCT in ineligible patients or as salvage. Treatment was a combination of bortezomib (1.5 mg/m2 weekly), cyclophosphamide (300 mg/m2 orally weekly), and dexamethasone (40 mg weekly). Seventeen patients received 2 to 6 cycles of CyBorD. Ten (58%) had symptomatic cardiac involvement, and 14 (82%) had 2 or more organs involved. Response occurred in 16 (94%), with 71% achieving complete hematologic response and 24% a partial response. Time to response was 2 months. Three patients originally not eligible for ASCT became eligible. CyBorD produces rapid and complete hematologic responses in the majority of patients with AL regardless of previous treatment or ASCT candidacy. It is well tolerated with few side effects. CyBorD warrants continued investigation as treatment for AL.
authors.affiliation: Mayo Clinic Arizona, Scottsdale, AZ 85259, USA. mikhael.joseph@mayo.edu
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Mikhael
authors.forename: Steven R
authors.initials: SR
authors.lastname: Schuster
authors.forename: Victor H
authors.initials: VH
authors.lastname: Jimenez-Zepeda
authors.forename: Nancy
authors.initials: N
authors.lastname: Bello
authors.forename: Jacy
authors.initials: J
authors.lastname: Spong
authors.forename: Craig B
authors.initials: CB
authors.lastname: Reeder
authors.forename: A Keith
authors.initials: AK
authors.lastname: Stewart
authors.forename: P Leif
authors.initials: PL
authors.lastname: Bergsagel
authors.forename: Rafael
authors.initials: R
authors.lastname: Fonseca
mesh_terms: D000682:Amyloid / Q000378:metabolism; D000686:Amyloidosis / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D000069286:Bortezomib; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D020732:Cytogenetic Analysis; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D011719:Pyrazines / Q000008:administration & dosage* / Q000009:adverse effects; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000682:Amyloid; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; D003907:Dexamethasone; D003520:Cyclophosphamide