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High-dose melphalan and autologous stem cell transplantation for systemic light-chain amyloidosis: a single institution retrospective analysis of 40 cases

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Abstract

We report our retrospective analysis of 40 patients who received high-dose melphalan and autologous stem cell transplantation for systemic immunoglobulin light-chain (AL) amyloidosis. Between 2006 and 2013, 40 patients with AL amyloidosis were transplanted at our medical center. Their median age was 54 years (range 32–70 years): 18 were male. The dominant organs involved were the heart in 13 patients, and kidney in 22: and other organs were involved in five. The median melphalan dose administered was 129 (range 50–200) mg/m2, and the median infused CD34+ cells was 2.69 (range 1.17–11.26) × 106/kg. Of the 40 patients, 30 are alive after a median follow-up of 42 (range 12–94) months, and the 4-year estimated overall survival rate was 74 % (95 % CI 56–86 %). Four patients died ≤100 days post-ASCT (heart failure in three patients, bacteremia in one). The 4-year estimated survival of the patients with cardiac involvement was 54 %, significantly lower than that of the other patients (91 %). Hematological and organ responses were 52 and 50 %, respectively. Careful patient selection and experienced management are important, especially for patients with cardiac involvement. It is also important to develop additional treatment for patients who do not achieve a hematological and/or organ response.

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Authors and Affiliations

  1. Department of Hematology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan

    Nobuhiro Tsukada, Masahiro Ikeda, Sumito Shingaki, Kanji Miyazaki, Sohsuke Meshitsuka, Yumiko Yoshiki, Yu Abe & Kenshi Suzuki

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  1. Nobuhiro Tsukada
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  2. Masahiro Ikeda
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  3. Sumito Shingaki
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  4. Kanji Miyazaki
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  5. Sohsuke Meshitsuka
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  6. Yumiko Yoshiki
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  7. Yu Abe
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  8. Kenshi Suzuki
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Correspondence to Nobuhiro Tsukada.

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The authors declare that they have no conflict of interests related to the present study.

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Tsukada, N., Ikeda, M., Shingaki, S. et al. High-dose melphalan and autologous stem cell transplantation for systemic light-chain amyloidosis: a single institution retrospective analysis of 40 cases. Int J Hematol 103, 299–305 (2016). https://doi.org/10.1007/s12185-015-1922-x

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  • DOI: https://doi.org/10.1007/s12185-015-1922-x

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