Risk factors, treatments and outcomes of patients with light chain amyloidosis who relapse after autologous stem cell transplantation
Relapse after ASCT is an important factor affecting the long-term prognosis of patients with AL amyloidosis. However, the risk factors of relapse are unknown and there are limited studies on treatment outcomes of these patients. We retrospectively reviewed 170 patients with AL amyloidosis who underw...
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| Veröffentlicht in: | Bone marrow transplantation (Basingstoke) 2024-03, Vol.59 (3), p.350-358 |
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| description | Relapse after ASCT is an important factor affecting the long-term prognosis of patients with AL amyloidosis. However, the risk factors of relapse are unknown and there are limited studies on treatment outcomes of these patients. We retrospectively reviewed 170 patients with AL amyloidosis who underwent ASCT between 2010 and 2021. Seventy-six patients confirmed as relapse and the median time from ASCT to relapse was 39 months. On multivariate analysis of variables before and after ASCT, lambda restricted, dFLC >30 mg/L pre ASCT, reduced dose melphalan and dFLC >10 mg/L at 6 months after ASCT were independent risk factors for relapse, and achieving CR after induction therapy and renal response after ASCT were protective factors. Most relapsed patients were treated with bortezomib-based regimens (50%) followed by daratumumab-based regimens (22.2%) and other chemotherapy regimens (13.9%). The overall hematological response in evaluable patients was 68.2% with 56.8% achieving CR/VGPR. The median PFS and OS from post-transplant relapse were 25 months and 81 months, respectively. Patients receiving bortezomib or daratumumab showed a better survival compared to other chemotherapy regimens. In conclusion, this study identified independent risk factors of post-transplant relapse and demonstrated the superiority of bortezomib or daratumumab treatment for these patients.
Clinical trial registration
NCT04210791. |
| doi_str_mv | 10.1038/s41409-023-02185-z |
| format | Article |
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Clinical trial registration
NCT04210791.</description><identifier>ISSN: 0268-3369</identifier><identifier>ISSN: 1476-5365</identifier><identifier>EISSN: 1476-5365</identifier><identifier>DOI: 10.1038/s41409-023-02185-z</identifier><identifier>PMID: 38148411</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>13/100 ; 14/32 ; 692/308/2171 ; 692/499 ; Amyloidosis ; Amyloidosis - drug therapy ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Bortezomib ; Bortezomib - therapeutic use ; Cell Biology ; Chemotherapy ; Hematology ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunoglobulin Light-chain Amyloidosis - drug therapy ; Induction therapy ; Internal Medicine ; Medical prognosis ; Medicine ; Medicine & Public Health ; Melphalan ; Multivariate analysis ; Neoplasm Recurrence, Local - drug therapy ; Patients ; Public Health ; Retrospective Studies ; Risk Factors ; Stem Cell Transplantation ; Stem Cells ; Transplantation, Autologous ; Transplants & implants</subject><ispartof>Bone marrow transplantation (Basingstoke), 2024-03, Vol.59 (3), p.350-358</ispartof><rights>The Author(s), under exclusive licence to Springer Nature Limited 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Nature Limited.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-a51d0ab12ebb95484d6f031358488e3296d2a40e8e42af281cd949c44f34e2d63</citedby><cites>FETCH-LOGICAL-c375t-a51d0ab12ebb95484d6f031358488e3296d2a40e8e42af281cd949c44f34e2d63</cites><orcidid>0000-0002-0243-9426</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/s41409-023-02185-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/s41409-023-02185-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38148411$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhang, Yuanyuan</creatorcontrib><creatorcontrib>Guo, Jinzhou</creatorcontrib><creatorcontrib>Chen, Wencui</creatorcontrib><creatorcontrib>Zhao, Liang</creatorcontrib><creatorcontrib>Huang, Xianghua</creatorcontrib><title>Risk factors, treatments and outcomes of patients with light chain amyloidosis who relapse after autologous stem cell transplantation</title><title>Bone marrow transplantation (Basingstoke)</title><addtitle>Bone Marrow Transplant</addtitle><addtitle>Bone Marrow Transplant</addtitle><description>Relapse after ASCT is an important factor affecting the long-term prognosis of patients with AL amyloidosis. However, the risk factors of relapse are unknown and there are limited studies on treatment outcomes of these patients. We retrospectively reviewed 170 patients with AL amyloidosis who underwent ASCT between 2010 and 2021. Seventy-six patients confirmed as relapse and the median time from ASCT to relapse was 39 months. On multivariate analysis of variables before and after ASCT, lambda restricted, dFLC >30 mg/L pre ASCT, reduced dose melphalan and dFLC >10 mg/L at 6 months after ASCT were independent risk factors for relapse, and achieving CR after induction therapy and renal response after ASCT were protective factors. Most relapsed patients were treated with bortezomib-based regimens (50%) followed by daratumumab-based regimens (22.2%) and other chemotherapy regimens (13.9%). The overall hematological response in evaluable patients was 68.2% with 56.8% achieving CR/VGPR. The median PFS and OS from post-transplant relapse were 25 months and 81 months, respectively. Patients receiving bortezomib or daratumumab showed a better survival compared to other chemotherapy regimens. In conclusion, this study identified independent risk factors of post-transplant relapse and demonstrated the superiority of bortezomib or daratumumab treatment for these patients.
Clinical trial registration
NCT04210791.</description><subject>13/100</subject><subject>14/32</subject><subject>692/308/2171</subject><subject>692/499</subject><subject>Amyloidosis</subject><subject>Amyloidosis - drug therapy</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Bortezomib</subject><subject>Bortezomib - therapeutic use</subject><subject>Cell Biology</subject><subject>Chemotherapy</subject><subject>Hematology</subject><subject>Hematopoietic Stem Cell Transplantation</subject><subject>Humans</subject><subject>Immunoglobulin Light-chain Amyloidosis - drug therapy</subject><subject>Induction therapy</subject><subject>Internal Medicine</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Melphalan</subject><subject>Multivariate analysis</subject><subject>Neoplasm Recurrence, Local - drug therapy</subject><subject>Patients</subject><subject>Public Health</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stem Cell Transplantation</subject><subject>Stem Cells</subject><subject>Transplantation, Autologous</subject><subject>Transplants & implants</subject><issn>0268-3369</issn><issn>1476-5365</issn><issn>1476-5365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9v1DAQxS1ERZfCF-CALHHh0FD_S-IcUQUFqRJSVc7WbDLZdUns4HGE2jvfG7dbQOLAwfLh_ebNsx9jr6R4J4W2Z2SkEV0llC5H2rq6e8I20rRNVeumfso2QjW20rrpjtlzohshpDGifsaOtZXGGik37OeVp298hD7HRKc8J4Q8Y8jEIQw8rrmPMxKPI18g-wfhh897PvndPvN-Dz5wmG-n6IdIvoj7yBNOsBByGDMmDmuOU9zFlThlnHmP01T2QKBlgpCLawwv2NEIE-HLx_uEff344fr8U3X55eLz-fvLqtdtnSuo5SBgKxVut11dXjA0o9BS19ZYi1p1zaDACLRoFIzKyn7oTNcbM2qDamj0CXt78F1S_L4iZTd7ug8EAUtApzrRtK0Wpivom3_Qm7imUNIVysi2_LNoC6UOVJ8iUcLRLcnPkG6dFO6-JHcoyZWS3ENJ7q4MvX60XrczDn9GfrdSAH0AqEhhh-nv7v_Y_gJ_j5-7</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>Zhang, Yuanyuan</creator><creator>Guo, Jinzhou</creator><creator>Chen, Wencui</creator><creator>Zhao, Liang</creator><creator>Huang, Xianghua</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0243-9426</orcidid></search><sort><creationdate>20240301</creationdate><title>Risk factors, treatments and outcomes of patients with light chain amyloidosis who relapse after autologous stem cell transplantation</title><author>Zhang, Yuanyuan ; Guo, Jinzhou ; Chen, Wencui ; Zhao, Liang ; Huang, Xianghua</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-a51d0ab12ebb95484d6f031358488e3296d2a40e8e42af281cd949c44f34e2d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>13/100</topic><topic>14/32</topic><topic>692/308/2171</topic><topic>692/499</topic><topic>Amyloidosis</topic><topic>Amyloidosis - drug therapy</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Bortezomib</topic><topic>Bortezomib - therapeutic use</topic><topic>Cell Biology</topic><topic>Chemotherapy</topic><topic>Hematology</topic><topic>Hematopoietic Stem Cell Transplantation</topic><topic>Humans</topic><topic>Immunoglobulin Light-chain Amyloidosis - drug therapy</topic><topic>Induction therapy</topic><topic>Internal Medicine</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Melphalan</topic><topic>Multivariate analysis</topic><topic>Neoplasm Recurrence, Local - drug therapy</topic><topic>Patients</topic><topic>Public Health</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stem Cell Transplantation</topic><topic>Stem Cells</topic><topic>Transplantation, Autologous</topic><topic>Transplants & implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Yuanyuan</creatorcontrib><creatorcontrib>Guo, Jinzhou</creatorcontrib><creatorcontrib>Chen, Wencui</creatorcontrib><creatorcontrib>Zhao, Liang</creatorcontrib><creatorcontrib>Huang, Xianghua</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Bone marrow transplantation (Basingstoke)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Yuanyuan</au><au>Guo, Jinzhou</au><au>Chen, Wencui</au><au>Zhao, Liang</au><au>Huang, Xianghua</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors, treatments and outcomes of patients with light chain amyloidosis who relapse after autologous stem cell transplantation</atitle><jtitle>Bone marrow transplantation (Basingstoke)</jtitle><stitle>Bone Marrow Transplant</stitle><addtitle>Bone Marrow Transplant</addtitle><date>2024-03-01</date><risdate>2024</risdate><volume>59</volume><issue>3</issue><spage>350</spage><epage>358</epage><pages>350-358</pages><issn>0268-3369</issn><issn>1476-5365</issn><eissn>1476-5365</eissn><abstract>Relapse after ASCT is an important factor affecting the long-term prognosis of patients with AL amyloidosis. However, the risk factors of relapse are unknown and there are limited studies on treatment outcomes of these patients. We retrospectively reviewed 170 patients with AL amyloidosis who underwent ASCT between 2010 and 2021. Seventy-six patients confirmed as relapse and the median time from ASCT to relapse was 39 months. On multivariate analysis of variables before and after ASCT, lambda restricted, dFLC >30 mg/L pre ASCT, reduced dose melphalan and dFLC >10 mg/L at 6 months after ASCT were independent risk factors for relapse, and achieving CR after induction therapy and renal response after ASCT were protective factors. Most relapsed patients were treated with bortezomib-based regimens (50%) followed by daratumumab-based regimens (22.2%) and other chemotherapy regimens (13.9%). The overall hematological response in evaluable patients was 68.2% with 56.8% achieving CR/VGPR. The median PFS and OS from post-transplant relapse were 25 months and 81 months, respectively. Patients receiving bortezomib or daratumumab showed a better survival compared to other chemotherapy regimens. In conclusion, this study identified independent risk factors of post-transplant relapse and demonstrated the superiority of bortezomib or daratumumab treatment for these patients.
Clinical trial registration
NCT04210791.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>38148411</pmid><doi>10.1038/s41409-023-02185-z</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0243-9426</orcidid></addata></record> |
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| ispartof | Bone marrow transplantation (Basingstoke), 2024-03, Vol.59 (3), p.350-358 |
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| subjects | 13/100 14/32 692/308/2171 692/499 Amyloidosis Amyloidosis - drug therapy Antineoplastic Combined Chemotherapy Protocols - therapeutic use Bortezomib Bortezomib - therapeutic use Cell Biology Chemotherapy Hematology Hematopoietic Stem Cell Transplantation Humans Immunoglobulin Light-chain Amyloidosis - drug therapy Induction therapy Internal Medicine Medical prognosis Medicine Medicine & Public Health Melphalan Multivariate analysis Neoplasm Recurrence, Local - drug therapy Patients Public Health Retrospective Studies Risk Factors Stem Cell Transplantation Stem Cells Transplantation, Autologous Transplants & implants |
| title | Risk factors, treatments and outcomes of patients with light chain amyloidosis who relapse after autologous stem cell transplantation |
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