TY - JOUR
T1 - Bortezomib-Based Induction Is Associated with Superior Outcomes in Light Chain Amyloidosis Patients Treated with Autologous Hematopoietic Cell Transplantation Regardless of Plasma Cell Burden
AU - Cornell, Robert F.
AU - Fraser, Raphael
AU - Costa, Luciano
AU - Goodman, Stacey
AU - Estrada-Merly, Noel
AU - Lee, Cindy
AU - Hildebrandt, Gerhard
AU - Gergis, Usama
AU - Farhadfar, Nosha
AU - Freytes, César O.
AU - Kamble, Rammurti T.
AU - Krem, Maxwell
AU - Kyle, Robert A.
AU - Lazarus, Hillard M.
AU - Marks, David I.
AU - Meehan, Kenneth
AU - Patel, Sagar S.
AU - Ramanathan, Muthalagu
AU - Olsson, Richard F.
AU - Wagner, John L.
AU - Kumar, Shaji
AU - Qazilbash, Muzaffar H.
AU - Shah, Ninah
AU - Hari, Parameswaran
AU - D'Souza, Anita
N1 - Publisher Copyright:
© 2020 The American Society for Transplantation and Cellular Therapy
PY - 2021/3
Y1 - 2021/3
N2 - The benefits of pre-transplant induction chemotherapy in light chain (AL) amyloidosis, a low burden plasma cell (PC) neoplasm associated with multiorgan dysfunction, is debatable, although with the availability of bortezomib, this approach is being increasingly pursued. We analyzed the outcomes of AL amyloidosis patients undergoing autologous hematopoietic cell transplant between 2014 and 2018 that were reported to the Center for International Blood and Marrow Transplant Research database. Of 440 patients, 294 received bortezomib-based induction, and 146 received no induction. Patients receiving induction had greater PC burden compared to no induction (PC 10% or more, 39% versus 11%; P <.01). At 2 years, the induction group compared to no induction had lower relapse/progression: 13% (9% to 18%) versus 23% (16% to 32%) (P =.02); better progression-free survival (PFS): 82% (77% to 87%) versus 69% (61% to 77%) (P <.01); and similar overall survival (OS): 92% (88% to 95%) versus 89% (84% to 94%) (P =.22), findings that were confirmed on multivariate analysis. A subset analysis limited to patients with <10% PC also showed superior relapse/progression (hazard ratio [HR],.43; 95% confidence interval [CI],.24 to.78; P <.01) and PFS (HR,.43; 95% CI,.26 to.72; P <.01) for induction compared to no induction. Thus, we conclude that pre-transplant bortezomib-based induction was associated with improved relapse/progression and PFS in AL amyloidosis. Longer survival follow-up is warranted, as OS was excellent in both cohorts at 2 years.
AB - The benefits of pre-transplant induction chemotherapy in light chain (AL) amyloidosis, a low burden plasma cell (PC) neoplasm associated with multiorgan dysfunction, is debatable, although with the availability of bortezomib, this approach is being increasingly pursued. We analyzed the outcomes of AL amyloidosis patients undergoing autologous hematopoietic cell transplant between 2014 and 2018 that were reported to the Center for International Blood and Marrow Transplant Research database. Of 440 patients, 294 received bortezomib-based induction, and 146 received no induction. Patients receiving induction had greater PC burden compared to no induction (PC 10% or more, 39% versus 11%; P <.01). At 2 years, the induction group compared to no induction had lower relapse/progression: 13% (9% to 18%) versus 23% (16% to 32%) (P =.02); better progression-free survival (PFS): 82% (77% to 87%) versus 69% (61% to 77%) (P <.01); and similar overall survival (OS): 92% (88% to 95%) versus 89% (84% to 94%) (P =.22), findings that were confirmed on multivariate analysis. A subset analysis limited to patients with <10% PC also showed superior relapse/progression (hazard ratio [HR],.43; 95% confidence interval [CI],.24 to.78; P <.01) and PFS (HR,.43; 95% CI,.26 to.72; P <.01) for induction compared to no induction. Thus, we conclude that pre-transplant bortezomib-based induction was associated with improved relapse/progression and PFS in AL amyloidosis. Longer survival follow-up is warranted, as OS was excellent in both cohorts at 2 years.
KW - Bone marrow transplant
KW - Hem malignancies
KW - Myeloma
UR - https://www.scopus.com/pages/publications/85101183550
U2 - 10.1016/j.jtct.2020.11.018
DO - 10.1016/j.jtct.2020.11.018
M3 - Article
C2 - 33781533
AN - SCOPUS:85101183550
SN - 2666-6375
VL - 27
SP - 264.e1-264.e7
JO - Transplantation and Cellular Therapy
JF - Transplantation and Cellular Therapy
IS - 3
ER -