title: Refinement in patient selection to reduce treatment-related mortality from autologous stem cell transplantation in amyloidosis.
abstract: This study sought to develop selection guidelines to determine the eligibility for SCT of patients with light-chain amyloidosis. Patients with biopsy-confirmed lightchain amyloidosis who underwent SCT between 8 March 1996 and 31 December 2011 were reviewed in two cohorts by date of transplantation: between 8 March 1996 and 30 June 2009 (n=410) and between 1 July 2009 and 31 December 2011 (n=89). Also evaluated were patients who died before post-transplant day 100 to determine the features predictive of early death. After 1 July 2009, fewer transplant recipients had Mayo stage III cardiac involvement. Mortality before post-transplant day 100 was 10.5% (43/410) in the earlier group and 1.1% (1/89) in the later group. In the earlier group, one-quarter of transplant recipients with N-terminal pro-brain natriuretic peptide (NT-proBNP) >5000 pg/mL died by 10.3 months. When serum troponin T was >0.06 ng/mL, 25% died at 3.7 months. The Mayo staging system is predictive for OS but not useful for selecting transplant recipients. Patients with serum troponin T >0.06 ng/mL or NT-proBNP >5000 pg/mL (not on dialysis) should not be considered candidates for SCT because of early mortality.
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA. gertz.morie@mayo.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Gertz
authors.forename: M Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: A
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: S K
authors.initials: SK
authors.lastname: Kumar
authors.forename: D
authors.initials: D
authors.lastname: Dingli
authors.forename: N
authors.initials: N
authors.lastname: Leung
authors.forename: W J
authors.initials: WJ
authors.lastname: Hogan
authors.forename: F K
authors.initials: FK
authors.lastname: Buadi
authors.forename: S R
authors.initials: SR
authors.lastname: Hayman
mesh_terms: D000686:Amyloidosis / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018579:Patient Selection; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D015996:Survival Rate; D013997:Time Factors; D014182:Transplantation, Autologous; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T; D020097:Natriuretic Peptide, Brain