Stem Cell Transplantation in Patients With Amyloidosis Involving 3 or More Organs Is Safe

The following article features coverage from the American Society of Clinical Oncology 2019 meeting. Click here to read more of Hematology Advisor’s conference coverage.

Autologous stem cell transplantation (ASCT) may be safe in patients with light chain amyloidosis involving 3 or more organs, according to research presented at the 2019 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois.

Currently, “most [transplant] centers limit transplantation to patients who have no more than 2 organs significantly involved,” the researchers wrote.

The researchers conducted a retrospective analysis of data from 75 patients with amyloidosis and involvement in at least 3 organs who underwent ASCT. The heart (95%) and kidneys (84%) were the most common sites of involvement.

Prior to ASCT, 4% of patients received 140 mg/m² melphalan, 45% received 200 mg/m² melphalan, and 51% received no induction treatment.

Patients demonstrated a median progression-free survival (PFS) of 16.3 months and a median overall survival (OS) of 68.9 months. The overall response rate was 75%. Mortality at 100 days was 16%; mortality overall was 59%.

Predictors for both PFS and OS included Mayo stage III or IV disease (P =.0012 for PFS; P <.0001 for OS) and hematologic response (very good partial response or better, P =.012 for PFS; any, P <.0001 for OS). Additionally, an NT-proBNP level of at least 2000 pg/mL was found to be prognostic (P =.001) and independently predictive of decreased PFS (P =.0001). Extent of organ involvement did not correlate with either PFS or OS.

The researchers concluded that “high prevalence of cardiac involvement is the main driver for the poor outcome in patients who have 3 or more organs involved.” Consequently, they recommended that these patients be considered eligible for ASCT.

Reference

1.     Al Saleh A, Sidiqi MH, Dispenzieri A, et al. Outcomes of patients with light chain amyloidosis who had autologous stem cell transplantation with three or more organs involved. Poster presentation at: 2019 ASCO Annual Meeting; June 3, 2019; Chicago, IL. Abstract 8011.