title: Effect of severe hypoalbuminemia on toxicity of high-dose melphalan and autologous stem cell transplantation in patients with AL amyloidosis.
abstract: High-dose melphalan with stem cell transplantation (HDM/SCT) extends survival and induces hematologic and clinical responses in patients with light chain (AL) amyloidosis. Eighty percent of melphalan is bound to plasma proteins (60% albumin-bound). We hypothesized that patients with profound hypoalbuminemia have a greater free melphalan fraction and more toxicity. Patients with AL amyloidosis treated with HDM/SCT between 2011 and 2014 with severe hypoalbuminemia (SH), defined as serum albumin ⩽2 g/dL were studied retrospectively. Sixteen patients with SH were identified. Forty-one patients without severe hypoalbuminemia (WSH) treated between 2011 and 2012 served as control. The incidence of acute renal failure requiring hemodialysis was 25% among patients with SH, compared with 5% among patients WSH (P=0.05). Not all patients who needed dialysis required it long term; 6.25% for SH and 2.44% for WSH (P=0.49). The rates of grade 3 or 4 febrile neutropenia and gastrointestinal toxicities were not significantly different between the groups. Engraftment kinetics were similar for both groups. Grade 4 renal toxicity and grade 3 lightheadedness were more frequent in patients with SH undergoing HDM/SCT for AL amyloidosis. Further studies into the mechanism of increased renal toxicity in patients with SH are warranted.
authors.affiliation: Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.|Section of Hematology/Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: S Y
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Section of Hematology/Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Meehan
authors.affiliation: Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.|Section of Hematology/Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Seldin
authors.affiliation: Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.|Section of Hematology/Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Sloan
authors.affiliation: Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.|Section of Hematology/Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Quillen
authors.affiliation: Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.|Section of Hematology/Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Shelton
authors.affiliation: Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.|Section of Hematology/Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Brauneis
authors.affiliation: Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.|Section of Hematology/Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: V
authors.initials: V
authors.lastname: Sanchorawala
mesh_terms: D016022:Case-Control Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications*; D000075363:Immunoglobulin Light-chain Amyloidosis / Q000150:complications / Q000628:therapy*; D007674:Kidney Diseases / Q000139:chemically induced; D008297:Male; D008558:Melphalan / Q000008:administration & dosage* / Q000633:toxicity; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D014182:Transplantation, Autologous
chemical_list: D008558:Melphalan