High-dose therapy with auto-SCT is feasible in high-risk cardiac amyloidosis

Cardiac involvement in light-chain amyloidosis (AL) predicts poor prognosis and is associated with higher TRM and morbidity during high-dose therapy and auto-SCT (HDT–ASCT). We studied the outcomes of 30 patients with cardiac amyloidosis undergoing HDT–ASCT at our center between January 1998 and March 2012. The median age of the patients was 53 years (range, 36–74) with a median follow-up of 35 months (range, 0.4–97 months). Twenty-seven patients (90%) had more than one organ involved besides the heart with 37% with cardiac stage ⩾3. Melphalan-based conditioning regimen (140–200 mg/m 2 ) was used for HDT–ASCT. One-year TRM is 10%. Three-year OS and EFS from HDT–ASCT was 83% and 56.8%, respectively. Cumulative incidence of relapse at 3 years was 38.5%. Negative factors affecting survival included age >60 years, lack of novel induction therapy and BM plasmacytosis >10%. We conclude that HDT–ASCT is well tolerated in patients with high-risk cardiac amyloidosis and can lead to improved overall outcomes.