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Autologous stem cell transplantation in light-chain amyloidosis

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Summary

Treatment of patients with light-chain amyloidosis (AL amyloidosis) has changed over the last 20 years, and early mortality rates have decreased with prolongation of survival. However, many patients are not cured with conventional therapy. Therefore, all patients should be assessed at diagnosis to determine eligibility for autologous stem cell transplantation (ASCT) since high-dose melphalan and ASCT have been shown to induce long-term hematologic and clinical responses with treatment-related mortality (TRM) <5%. Earlier diagnosis, improvement of supportive care, and deeper remissions with recently available first-line therapy have substantially reduced TRM. However, procedures and experience in complex AL amyloidosis patients still vary between transplant centers because a multidisciplinary team is necessary for an individual risk-adapted approach.

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References

  1. Comenzo RL, Vosburgh E, Simms RW, Bergethon P, Sarnacki D, Finn K, et al. Dose-intensive melphalan with blood stem cell support for the treatment of AL amyloidosis: one-year follow-up in five patients. Blood. 1996;88:2801–6.

    Article  CAS  Google Scholar 

  2. Passweg JR, Baldomero H, Bader P, Bonini C, Duarte RF, Dufour C, et al. Use of haploidentical stem cell transplantation continues to increase: the 2015 European Society for Blood and Marrow Transplant activity survey report. Bone Marrow Transplant. 2017;52:811–7.

    Article  CAS  Google Scholar 

  3. Dispenzieri A, Kyle RA, Lacy MQ, Therneau TM, Larson DR, Plevak MF, et al. Superior survival in primary systemic amyloidosis patients undergoing peripheral blood stem cell transplantation: a case-control study. Blood. 2004;103:3960–3.

    Article  CAS  Google Scholar 

  4. Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Kumar SK, Dingli D, et al. Autologous stem cell transplant for immunoglobulin light chain amyloidosis: a status report. Leuk Lymphoma. 2010;51:2181–7.

    Article  Google Scholar 

  5. Rosengren S, Mellqvist UH, Nahi H, Forsberg K, Lenhoff S, Strömberg O, et al. Outcome of AL amyloidosis after high-dose melphalan and autologous stem cell transplantation in Sweden, long-term results from all patients treated in 1994–2009. Bone Marrow Transplant. 2016;51:1569–72.

    Article  CAS  Google Scholar 

  6. Cohen AD, Zhou P, Chou J, Teruya-Feldstein J, Reich L, Hassoun H, et al. Risk-adapted autologous stem cell transplantation with adjuvant dexamethasone +/− thalidomide for systemic light-chain amyloidosis: results of a phase II trial. Br J Haematol. 2007;139:224–33.

    Article  CAS  Google Scholar 

  7. Moreau P, Leblond V, Bourquelot P, Facon T, Huynh A, Caillot D, et al. Prognostic factors for survival and response after high-dose therapy and autologous stem cell transplantation in systemic AL amyloidosis: a report on 21 patients. Br J Haematol. 1998;101:766–9.

    Article  CAS  Google Scholar 

  8. Sorror ML, Maris MB, Storb R, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106:2912–9.

    Article  CAS  Google Scholar 

  9. Berro M, Arbelbide JA, Rivas MM, Basquiera AL, Ferini G, Vitriu A, et al. Hematopoietic cell transplantation-specific comorbidity index predicts morbidity and mortality in autologous stem cell transplantation. Biol Blood Marrow Transplant. 2017;23:1646–50.

    Article  Google Scholar 

  10. Saad A, Mahindra A, Zhang M, Zhong X, Costa LJ, Dispenzieri A, et al. Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma. Biol Blood Marrow Transplant. 2014;20:402–408.e1.

    Article  Google Scholar 

  11. Gertz MA, Lacy MQ, Dispenzieri A, Kumar SK, Dingli D, Leung N, et al. Refinement in patient selection to reduce treatment-related mortality from autologous stem cell transplantation in amyloidosis. Bone Marrow Transplant. 2013;48:557–61.

    Article  CAS  Google Scholar 

  12. Skinner M, Sanchorawala V, Seldin DC, Dember LM, Falk RH, Berk JL, et al. High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: an 8‑year study. Ann Intern Med. 2004;140:85–93.

    Article  CAS  Google Scholar 

  13. Girnius S, Seldin DC, Meier-Ewert HK, Sloan JM, Quillen K, Ruberg FL, et al. Safety and efficacy of high-dose melphalan and auto-SCT in patients with AL amyloidosis and cardiac involvement. Bone Marrow Transplant. 2014;49:434–9.

    Article  CAS  Google Scholar 

  14. D’Souza A, Dispenzieri A, Wirk B, Zhang MJ, Huang J, Gertz MA, et al. Improved outcomes after autologous hematopoietic cell transplantation for light chain amyloidosis: a center for international blood and marrow transplant research study. J Clin Oncol. 2015;33:3741–9.

    Article  Google Scholar 

  15. Sidana S, Sidiqi MH, Dispenzieri A, Buadi FK, Lacy MQ, Muchtar E, et al. Fifteen year overall survival rates after autologous stem cell transplantation for AL amyloidosis. Am J Hematol. 2019;94:1020–6.

    Article  CAS  Google Scholar 

  16. Sanchorawala V, Sun F, Quillen K, Sloan JM, Berk JL, Seldin DC. Long-term outcome of patients with AL amyloidosis treated with high-dose melphalan and stem cell transplantation: 20-year experience. Blood. 2015;126:2345–7.

    Article  Google Scholar 

  17. Cibeira MT, Sanchorawala V, Seldin DC, Quillen K, Berk JL, Dember LM, et al. Outcome of AL amyloidosis after high-dose melphalan and autologous stem cell transplantation: long-term results in a series of 421 patients. Blood. 2011;118:4346–52.

    Article  CAS  Google Scholar 

  18. Gertz MA, Lacy MQ, Dispenzieri A, Buadi FK, Dingli D, Hayman SR, et al. Stem cell transplantation compared with melphalan plus dexamethasone in the treatment of immunoglobulin light-chain amyloidosis. Cancer. 2016;122:2197–205.

    Article  CAS  Google Scholar 

  19. Abdallah N, Sidana S, Dispenzieri A, Lacy M, Buadi F, Hayman S, et al. Outcomes with early vs. deferred stem cell transplantation in light chain amyloidosis. Bone Marrow Transplant. 2020;55:1297–1304.

    Article  Google Scholar 

  20. Kourelis TV, Kumar SK, Gertz MA, Lacy MQ, Buadi FK, Hayman SR, et al. Coexistent multiple myeloma or increased bone marrow plasma cells define equally high-risk populations in patients with immunoglobulin light chain amyloidosis. J Clin Oncol. 2013;31:4319–24.

    Article  CAS  Google Scholar 

  21. Al Saleh AS, Sidiqi MH, Sidana S, Muchtar E, Dispenzieri A, Dingli D, et al. Impact of consolidation therapy post autologous stem cell transplant in patients with light chain amyloidosis. Am J Hematol. 2019;94:1066–71.

    Article  Google Scholar 

  22. Minnema MC, Nasserinejad K, Hazenberg B, Hegenbart U, Vlummens P, Ypma PF, et al. Bortezomib-based induction followed by stem cell transplantation in light chain amyloidosis: results of the multicenter HOVON 104 trial. Haematologica. 2019;104:2274–82.

    Article  CAS  Google Scholar 

  23. Wechalekar AD, Hawkins PN, Gillmore JD. Perspectives in treatment of AL amyloidosis. Br J Haematol. 2008;140:365–77.

    Article  CAS  Google Scholar 

  24. Gertz MA, Lacy MQ, Dispenzieri A, Ansell SM, Elliott MA, Gastineau DA, et al. Risk-adjusted manipulation of melphalan dose before stem cell transplantation in patients with amyloidosis is associated with a lower response rate. Bone Marrow Transplant. 2004;34:1025–31.

    Article  CAS  Google Scholar 

  25. Tandon N, Muchtar E, Sidana S, Dispenzieri A, Lacy MQ, Dingli D, et al. Revisiting conditioning dose in newly diagnosed light chain amyloidosis undergoing frontline autologous stem cell transplant: impact on response and survival. Bone Marrow Transplant. 2017;52:1126–32.

    Article  CAS  Google Scholar 

  26. Tandon N, Muchtar E, Sidana S, Dispenzieri A, Lacy MQ, Dingli D, Buadi FK, Hayman SR, Chakraborty R, Hogan WJ, Gonsalves W, Warsame R, Kourelis TV, Leung N, Kapoor P, Kumar SK, Gertz MA. Revisiting conditioning dose in newly diagnosed light chain amyloidosis undergoing frontline autologous stem cell transplant: impact on response and survival. Bone Marrow Transplant. 2017; 52(8):1126–32.

    Article  CAS  Google Scholar 

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  1. 3rd Medical Department, Hanusch Krankenhaus, Heinrich-Collin-Straße 30, 1140, Vienna, Austria

    Alexandra Böhm

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  1. Alexandra Böhm
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A. Böhm declares that she has no competing interests.

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Böhm, A. Autologous stem cell transplantation in light-chain amyloidosis. memo 14, 111–114 (2021). https://doi.org/10.1007/s12254-020-00644-7

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