Impact of Induction Therapy on the Outcome of Immunoglobulin Light Chain Amyloidosis after Autologous Hematopoietic Stem Cell Transplantation

被引:22
作者
Afrough, Aimaz [1 ]
Saliba, Rima M. [1 ]
Hamdi, Amir [1 ]
Honhar, Medhavi [2 ]
Varma, Ankur [3 ]
Cornelison, A. Megan [1 ]
Rondon, Gabriela [1 ]
Parmar, Simrit [1 ]
Shah, Nina D. [1 ]
Bashir, Qaiser [1 ]
Hosing, Chitra [1 ]
Popat, Uday [1 ]
Weber, Donna M. [4 ]
Thomas, Sheeba [4 ]
Orlowski, Robert Z. [4 ]
Champlin, Richard E. [1 ]
Qazilbash, Muzaffar H. [1 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat & Cellular Therapy, Unit 423,1515 Holcombe Blvd, Houston, TX 77030 USA
[2] Univ Texas Med Branch, Dept Pediat, Galveston, TX 77555 USA
[3] Baylor Coll Med, Dept Hematol Oncol, Houston, TX 77030 USA
[4] Univ Texas MD Anderson Canc Ctr, Dept Lymphoma & Myeloma, Houston, TX 77030 USA
关键词
AL amyloidosis; Induction therapy; Autologous hematopoietic stem; cell transplantation; Response; Survival; HIGH-DOSE MELPHALAN; SYSTEMIC AL AMYLOIDOSIS; HEMATOLOGIC RESPONSE; AUTO-SCT; BORTEZOMIB; DEXAMETHASONE; SURVIVAL; CYCLOPHOSPHAMIDE; CHEMOTHERAPY; FEASIBILITY;
D O I
10.1016/j.bbmt.2018.07.010
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
With the availability of immunomodulatory imide drugs (IMiDs) and proteasome inhibitors (PI), most patients with immunoglobulin light chain amyloidosis (AL) receive induction therapy before autologous hematopoietic stem cell transplantation (auto-HCT). In this study we evaluated the type of induction therapy and its impact on the outcome of auto-HCT in AL. We identified 128 patients with AL who underwent high-dose chemotherapy and auto-HCT at our institution between 1997 and 2013. Patients were divided into 3 groups: no induction, conventional chemotherapy (CC)-based induction (melphalan, steroids), and IMiD/PI-based induction (thalidomide, lenalidomide, or bortezomib). The hematologic response (HR) and organ response were defined according to the established criteria. Median age at auto-HCT was 58 years (range, 35 to 75). Twenty patients (15.5%) received no induction, 25 (19.5%) received CC, and 83 (65%) received IMiDs/Pls. One, 2, or 3 or more organs were involved in 90 (70%), 20 (16%), and 18 (14%) patients, respectively. After auto-HCT 12 of 20 (60%),15 of 24 (62%), and 72 of 83 (87%) assessable patients achieved HR at 100 days in no induction, CC, and IMiD/PI groups, respectively (P = .001). Organ response at 1 year after auto-HCT was seen in 7 of 18 (39%), 14 of 24 (58%), and 37 of 79 (47%) assessable patients in no induction, CC, and IMiD/PI groups, respectively (P = .3). Achieving a hematologic complete response was associated with a significantly higher probability of achieving an organ response (P = .02). After a median follow-up of 26 months, rates of 2-year progression-free survival were 67%, 56%, and 73% in no induction, CC, and IMiD/PI groups, respectively (P= .07; hazard ratio, .5; 95% confidence interval [CI], .3 to 1.1). Rates of 2-year overall survival were 73%, 76%, and 87% in no induction, CC, and IMiD/PI groups, respectively (P= .05; hazard ratio, .4; 95% CI, .2 to .9). On multivariate analysis a low beta(2)-microglobulin (P = .01; hazard ratio, .3; 95% Cl, .1 to .7) and induction therapy with IMiD/PI (P = .01; hazard ratio, .3; 95% CI, .1 to .7) were associated with a better overall survival. Induction therapy with either CC or IMiDs/Pls is safe and feasible in selected patients with AL. IMiD/PI-based induction is associated with a longer overall survival compared with patients who received no induction or CC before auto-HCT. (C) 2018 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:2197 / 2203
页数:7
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