Bortezomib-Based Induction Is Associated with Superior Outcomes in Light Chain Amyloidosis Patients Treated with Autologous Hematopoietic Cell Transplantation Regardless of Plasma Cell Burden
Year: 2020
Type: article
Study design: Observational Study
Abstract: The benefits of pre-transplant induction chemotherapy in light chain (AL) amyloidosis, a low burden plasma cell (PC) neoplasm associated with multiorgan dysfunction, is debatable, although with the availability of bortezomib, this approach is being increasingly pursued. We analyzed the outcomes of AL amyloidosis patients undergoing autologous hematopoietic cell transplant between 2014 and 2018 that were reported to the Center for International Blood and Marrow Transplant Research database. Of 440 patients, 294 received bortezomib-based induction, and 146 received no induction. Patients receiving induction had greater PC burden compared to no induction (PC 10% or more, 39% versus 11%; P < .01). At 2 years, the induction group compared to no induction had lower relapse/progression: 13% (9% to 18%) versus 23% (16% to 32%) (P = .02); better progression-free survival (PFS): 82% (77% to 87%) versus 69% (61% to 77%) (P < .01); and similar overall survival (OS): 92% (88% to 95%) versus 89% (84% to 94%) (P = .22), findings that were confirmed on multivariate analysis. A subset analysis limited to patients with <10% PC also showed superior relapse/progression (hazard ratio [HR], .43; 95% confidence interval [CI], .24 to .78; P < .01) and PFS (HR, .43; 95% CI, .26 to .72; P < .01) for induction compared to no induction. Thus, we conclude that pre-transplant bortezomib-based induction was associated with improved relapse/progression and PFS in AL amyloidosis. Longer survival follow-up is warranted, as OS was excellent in both cohorts at 2 years.
Authors: Robert F. Cornell, Raphael Fraser, Luciano Costa, Stacey Goodman, Noel Estrada-Merly, Cindy Lee, Gerhard Hildebrandt, Usama Gergis, Nosha Farhadfar, César O. Freytes, Rammurti T. Kamble, Maxwell Krem, Robert A. Kyle, Hillard M. Lazarus, David I. Marks, Kenneth Meehan, Sagar S. Patel, Muthalagu Ramanathan, Richard F. Olsson, John L. Wagner, Shaji Kumar, Muzaffar H. Qazilbash, Ninah Shah, Parameswaran Hari, Anita D'Souza
Institutions: AbbVie (United States), Medical College of Wisconsin, University of Alabama at Birmingham, Vanderbilt University Medical Center, Royal Adelaide Hospital, University of Kentucky, Markey Cancer Center, Thomas Jefferson University, University of Florida Health, University of Florida, Baylor College of Medicine, Mayo Clinic, University Hospitals Cleveland Medical Center, Case Western Reserve University, University Hospitals Bristol NHS Foundation Trust, Dartmouth–Hitchcock Medical Center, University of Utah, UMass Memorial Medical Center, Uppsala University, Karolinska Institutet, The University of Texas MD Anderson Cancer Center, University of California, San Francisco
Language: English
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
Funders: U.S. Department of Defense, Stanford University, American Society of Clinical Oncology, Boston Children's Hospital, CSL Behring, Medical College of Wisconsin, Jazz Pharmaceuticals, Government of South Australia, Kyowa Kirin Pharmaceutical Development, Daiichi-Sankyo, Shire, National Institutes of Health, Health Resources and Services Administration, U.S. Public Health Service, U.S. Navy, Biomedical Advanced Research and Development Authority, Sanofi Genzyme, National Heart, Lung, and Blood Institute, Office of Naval Research, National Cancer Institute, National Institute of Allergy and Infectious Diseases, Janssen Biotech
Awards: Cost Effectiveness Analysis of Stem Cell Transplant in Older MDS Patients, Identifying Predictors of Poor Health-Related Quality-of-life among Pediatric Hematopoietic Stem Cell Donors, G1664930879, G2585567822, G3083416222, G3158753476, G345720138, G3699198379, G3700703953, G3869650085, G3922948135, G3928191929, G4334469717, G460283006, Cure Sickle Cell, G4898549738, G5079632146, G5186918478, G5356860631, G541923634, G563297368, G5735794559, G5843619112, G6079157135, G6463560129, G746619137, G772836402, G7766946159, G8039400965, G8871973681, Molecular and Cellular Mechanisms of Chronic Myelomonocytic Leukemia (CMML), Immuno and Epigenetics of Hematopoietic Cell Transplantation, A Data Resource for Blood and Marrow Transplants and Adoptive Cellular Therapy Research, NK cells, their receptors and cancer therapy, Blood and Marrow Transplant Clinical Trials Network DCC- The Medical College of Wisconsin, Inc., Hematopoietic Stem Cell And Cord Blood Transplantation
OpenAlex ID: W3116742931