Malnutrition at diagnosis predicts mortality in patients with systemic immunoglobulin light-chain amyloidosis independently of cardiac stage and response to treatment.
BACKGROUND
Nutrition status was shown to be a prognostic factor in patients with immunoglobulin light-chain amyloidosis (AL). However, malnutrition was associated with cardiac involvement, thus suggesting potential interactions. This study aim was to clarify the association among nutrition status, cardiac stage, and mortality in AL.


METHODS
One hundred twenty-eight consecutive newly diagnosed, treatment-naïve patients with histologically confirmed AL were enrolled. Anthropometric, biochemical, and clinical variables were assessed.


RESULTS
At multivariable Cox proportional hazard analysis, body mass index (BMI) < 22 kg/m(2) (HR = 1.98, 95% CI = 1.09-3.56) and unintentional 6-month weight loss (WL) ≥ 10% (HR = 1.94, 95% CI = 1.00-3.74) resulted in independent predictors of survival after controlling for hematologic response to treatment (HR = 0.27, 95% CI = 0.14-0.53) and cardiac stage (Mayo Clinic stage III, HR = 4.42, 95% CI = 2.61-7.51). There was no effect modification of malnutrition on mortality by cardiac stage (P for interaction = .27). Moderate and severe malnutrition (prevalence: 21.9% and 7.8%, respectively) similarly increased the risk of death (HR = 3.09, 95% CI = 1.75-5.46; 2.88, 95% CI = 1.23-6.72, respectively).


CONCLUSIONS
In AL, malnutrition at diagnosis is a frequent comorbidity that affects the prognosis independently of hematologic response to treatment and cardiac stage. Nutrition status should be systematically considered in future intervention trials in AL. Nutrition support trials are warranted.
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico, San Matteo, Italy r.caccialanza@smatteo.pv.it.
Riccardo
R
Caccialanza
Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Italy.
Giovanni
G
Palladini
Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico, San Matteo, Italy.
Catherine
C
Klersy
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico, San Matteo, Italy.
Emanuele
E
Cereda
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico, San Matteo, Italy.
Chiara
C
Bonardi
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico, San Matteo, Italy.
Barbara
B
Cameletti
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico, San Matteo, Italy.
Lara
L
Quarleri
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico, San Matteo, Italy.
Elisabetta
E
Montagna
Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Italy.
Andrea
A
Foli
Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Italy.
Paolo
P
Milani
Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Italy.
Francesca
F
Lavatelli
Medical Direction, Fondazione IRCCS Policlinico, San Matteo, Italy.
Carlo
C
Marena
Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Italy.
Giampaolo
G
Merlini
D000368:Aged; D000682:Amyloid / Q000378:metabolism*; D000686:Amyloidosis / Q000150:complications / Q000178:diet therapy / Q000401:mortality*; D015992:Body Mass Index; D002423:Cause of Death; D005260:Female; D006321:Heart; D006801:Humans; D007147:Immunoglobulin Light Chains; D000075363:Immunoglobulin Light-chain Amyloidosis; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D009752:Nutritional Status; D011379:Prognosis; D016016:Proportional Hazards Models
D000682:Amyloid; D007147:Immunoglobulin Light Chains
AL; amyloidosis; cardiac stage; malnutrition; survival; treatment response