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Early intensification and autologous stem cell transplantation in patients with systemic AL amyloidosis: a single-centre experience

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Abstract

Primary systemic amyloidosis (AL amyloidosis) continues to have a very poor prognosis. Most therapeutic strategies remain unsatisfactory. Conventional chemotherapy is known to offer at best only moderate efficacy. Several studies have yielded higher complete response rates after high-dose chemotherapy and autologous stem cell transplantation (ASCT) in addition to improving outcomes in a subgroup of patients. However, the superiority of an intensive approach in AL amyloidosis has not been confirmed in a randomised trial. The precise role of ASCT remains unclear. We report our experience in 16 patients diagnosed with AL amyloidosis and treated in a multidisciplinary approach with high-dose melphalan and ASCT. Median age was 59 (39–71) years. The kidneys were predominantly affected in 75% of cases; two or more organs were affected in 38%. Median time from diagnosis to transplantation was 2 (1–4) months. Three patients (19%) developed acute renal failure and required transient dialysis. Transplant-related mortality was 6% after 100 days. Haematological complete response (CR) was obtained in nine (56%) and organ response in six (38%) patients. Nine out of 12 patients (75%) with kidney involvement exhibited a sustained clinical benefit at 12 months. Half of all the patients (n = 8) were alive after a median follow-up of 33 months, including two in continuous CR. This suggests that high-dose chemotherapy and ASCT are still valid treatment options in AL amyloidosis and that a significant number of patients with renal involvement might benefit from this approach.

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Authors and Affiliations

  1. Department of Haematology, University Hospital CHUV, Lausanne, Switzerland

    Valérie Frossard, Anne Rosselet, Anne Cairoli, Michel A. Duchosal & Tibor Kovacsovics

  2. Department of Oncology, University Hospital CHUV, Lausanne, Switzerland

    Nicolas Ketterer

  3. Department of Nephrology, University Hospital CHUV, Lausanne, Switzerland

    Pascal Meier

  4. Multidisciplinary Oncology Centre, CHUV, BH-06, 1011, Lausanne, Switzerland

    Nicolas Ketterer

Authors
  1. Valérie Frossard
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  2. Nicolas Ketterer
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  3. Anne Rosselet
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  4. Pascal Meier
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  5. Anne Cairoli
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  6. Michel A. Duchosal
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  7. Tibor Kovacsovics
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Correspondence to Nicolas Ketterer.

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Frossard, V., Ketterer, N., Rosselet, A. et al. Early intensification and autologous stem cell transplantation in patients with systemic AL amyloidosis: a single-centre experience. Ann Hematol 88, 681–685 (2009). https://doi.org/10.1007/s00277-008-0652-z

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  • DOI: https://doi.org/10.1007/s00277-008-0652-z

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