TY - JOUR
T1 - Improving security of autologous hematopoietic stem cell transplant in patients with light-chain amyloidosis
AU - Gutiérrez-García, Gonzalo
AU - Cibeira, María Teresa
AU - Rovira, Montserrat
AU - Fernández de Larrea, Carlos
AU - Tovar, Natalia
AU - Rodríguez-Lobato, Luis Gerardo
AU - Rosiñol, Laura
AU - Marín, Pedro
AU - Solano-Vega, Julio
AU - Suárez-Lledó, María
AU - Bataller, Alex
AU - Solano, María Teresa
AU - de Llobet, Noemí
AU - Domenech, Ariadna
AU - Borràs, Nuria
AU - Lozano, Miquel
AU - Cid, Joan
AU - Martínez, Carmen
AU - Urbano-Ispizua, Álvaro
AU - Esteve, Jordi
AU - Carreras, Enric
AU - Fernández-Avilés, Francesc
AU - Bladé, Joan
N1 - Publisher Copyright:
© 2019, Springer Nature Limited.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Autologous stem cell transplant (ASCT) has demonstrated to be an effective treatment for patients with light-chain (AL) amyloidosis. However, a high transplant-related mortality (TRM) rate was reported in previous series of patients and questioned the role of transplant in this disease. Recently, experienced groups have shown a significant TRM decrease that has been attributed to an accurate selection of patients. Moreover, application of several supportive measures has decreased toxicity over amyloid-involved organs. We analyzed a series of 66 patients with AL amyloidosis, who underwent ASCT at a single institution and evaluated the impact of these measures beyond patient selection. Four temporary groups were established: group-A (non-selection plus post-transplant G-CSF use) with 29 patients, group-B (selection) with 13, group-C (selection and G-CSF avoidance) with 14, and group-D (selection, G-CSF avoidance and corticosteroid’s prophylaxis) with 10. A decreasing TRM was observed over time from group-A (38%), to group-D (0%); p = 0.02. We also observed a progressive increase of three-year OS from 62% in group-A to 100% in group-D; p = 0.049. On the multivariate analysis, cardiac involvement was the only independent predictor of survival. Therefore, tailored selection policy together with transplant supportive measures have allowed ASCT to be a safe procedure in AL amyloidosis.
AB - Autologous stem cell transplant (ASCT) has demonstrated to be an effective treatment for patients with light-chain (AL) amyloidosis. However, a high transplant-related mortality (TRM) rate was reported in previous series of patients and questioned the role of transplant in this disease. Recently, experienced groups have shown a significant TRM decrease that has been attributed to an accurate selection of patients. Moreover, application of several supportive measures has decreased toxicity over amyloid-involved organs. We analyzed a series of 66 patients with AL amyloidosis, who underwent ASCT at a single institution and evaluated the impact of these measures beyond patient selection. Four temporary groups were established: group-A (non-selection plus post-transplant G-CSF use) with 29 patients, group-B (selection) with 13, group-C (selection and G-CSF avoidance) with 14, and group-D (selection, G-CSF avoidance and corticosteroid’s prophylaxis) with 10. A decreasing TRM was observed over time from group-A (38%), to group-D (0%); p = 0.02. We also observed a progressive increase of three-year OS from 62% in group-A to 100% in group-D; p = 0.049. On the multivariate analysis, cardiac involvement was the only independent predictor of survival. Therefore, tailored selection policy together with transplant supportive measures have allowed ASCT to be a safe procedure in AL amyloidosis.
UR - https://www.scopus.com/pages/publications/85060347436
U2 - 10.1038/s41409-019-0447-y
DO - 10.1038/s41409-019-0447-y
M3 - Article
C2 - 30664727
AN - SCOPUS:85060347436
SN - 0268-3369
VL - 54
SP - 1295
EP - 1303
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 8
ER -