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Acute kidney injury during autologous stem cell transplantation in light chain amyloidosis with kidney involvement and their impact on prognosis

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Abstract

Acute kidney injury (AKI) is a complication related to important organ dysfunction during autologous stem cell transplantation (ASCT) in light chain (AL) amyloidosis. This study aims to validate the risk factors of AKI during different periods of ASCT and the impact of AKI on long-term outcomes. 302 patients with AL amyloidosis and kidney involvement who underwent ASCT were included. The procedures from stem cell mobilization to 30 days after transplantation were categorized into four periods: Period 0 (stem cell mobilization and harvest), Period 1 (preparation), Period 2 (conditioning and transplantation), and Period 3 (engraftment). The incidence of AKI during ASCT was 27.15% (0.66% in Period 0, 6.62% in Period 1, 15.23% in Period 2, and 6.95% in Period 3). The major causes of AKI were capillary leak syndrome in Period 0, ganciclovir or sulfamethoxazole/trimethoprim in Period 1, high-dose melphalan in Period 2, and engraftment syndrome in Period 3. AKI in different periods had distinct risk factors and predictive models. AKI was a risk factor for both kidney survival and overall survival (OS). Even recovered AKI reduced 10-year kidney survival from 91.7% to 68.4% (p = 0.002) and 10-year OS from 91.1% to 77.7% (p = 0.005).

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Fig. 1: An overview of different periods of ASCT and AKI.
Fig. 2: Long-term survival outcomes in different groups of patients.
Fig. 3: Multivariate Cox regression with stepwise forward elimination of risk factors for long-term survival.

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Data availability

The datasets are available in deidentified form from the corresponding author on reasonable request considering about the patient privacy.

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Authors and Affiliations

  1. National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China

    Weiwei Xu, Wencui Chen, Jinzhou Guo, Liang Zhao, Guisheng Ren & Xianghua Huang

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  1. Weiwei Xu
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  2. Wencui Chen
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  3. Jinzhou Guo
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  4. Liang Zhao
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  5. Guisheng Ren
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Contributions

WWX was responsible for designing the study, extracting and analyzing data, interpreting results and writing the manuscript. WCC, JZG, LZ, GSR collected the data of the subjects. XHH was responsible for designing the protocol, interpreting results, and helped perform the analysis with constructive discussions.

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Correspondence to Xianghua Huang.

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Xu, W., Chen, W., Guo, J. et al. Acute kidney injury during autologous stem cell transplantation in light chain amyloidosis with kidney involvement and their impact on prognosis. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02292-5

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