The Effect of Bone Marrow Plasma Cell Burden on Survival in Patients with Light Chain Amyloidosis Undergoing High-Dose Melphalan and Autologous Stem Cell Transplantation.
The prognosis in light chain (AL) amyloidosis has been linked to several variables, which are primarily related to end-organ damage. Recently, bone marrow plasma cell (BMPC) burden >10% has also been described as an adverse prognostic factor. We reviewed data pertaining to 546 patients with AL amyloidosis who underwent high-dose melphalan (HDM) and stem cell transplantation (SCT) to determine if BMPC > 10% was a negative prognostic factor. Of these patients, 445 had a BMPC burden ≤ 10% and 101 had a BMPC burden > 10%. Patients with BMPC > 30% were excluded from the study. The median overall survival (OS) was 7.86 years (95% confidence interval [CI], 6.69 to 9.83) in patients with BMPC ≤ 10% and 6.8 years (95% CI, 5.75 to 10.17) for those with BMPC >10% (hazard ratio, 1.106; 95% CI, .78 to 1.45; P = .70) after HDM/SCT. Of the 101 patients with a BMPC burden > 10%, 25 received induction therapy. The median OS was 7.78 years (95% CI, 5.4 to 13.4) for those without induction therapy and 5.75 years (95% CI, 3.94 to not available; P = .28) for those with induction therapy. Furthermore, hematologic response and relapse rates did not differ in these 2 groups after HDM/SCT. We conclude that BMPC > 10% and < 30% is not a poor prognostic factor with respect to survival in patients with AL amyloidosis treated with HDM/SCT and that induction therapy in this group does not impact OS.
Amyloidosis Center, Boston University School of Medicine, Boston, Massachusetts.
Christopher
C
Dittus
Department of Medicine, Boston Medical Center, Boston, Massachusetts.
Nsabimana
N
Uwumugambi
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
Fangui
F
Sun
Amyloidosis Center, Boston University School of Medicine, Boston, Massachusetts.
J Mark
JM
Sloan
Amyloidosis Center, Boston University School of Medicine, Boston, Massachusetts. Electronic address: vaishali.sanchorawala@bmc.org.
Vaishali
V
Sanchorawala
D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D001856:Bone Marrow Examination; D002452:Cell Count; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D000075363:Immunoglobulin Light-chain Amyloidosis / Q000401:mortality / Q000628:therapy*; D008558:Melphalan / Q000008:administration & dosage*; D010950:Plasma Cells / Q000473:pathology*; D016019:Survival Analysis; D014182:Transplantation, Autologous
D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan
Light chain (AL) amyloidosis; Melphalan; Plasma cells; Stem cell transplantation; Survival