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Melphalan and dexamethasone with or without bortezomib in newly diagnosed AL amyloidosis: a matched case–control study on 174 patients

Leukemia volume 28, pages 2311–2316 (2014)Cite this article

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Abstract

Oral melphalan and dexamethasone (MDex) is a standard treatment for patients with AL amyloidosis who are not eligible for stem cell transplantation at many referral centers. However, following encouraging reports on the activity of bortezomib combined with alkylators and dexamethasone, these combinations are being moved to frontline therapy. We compared the outcome of 87 patients treated with bortezomib plus MDex (BMDex) with that of 87 controls treated with MDex. Patients and controls were matched for age, cardiac and renal function and free light chain burden. A higher rate of complete responses was observed with BMDex (42 vs 19%), but this did not result in a survival improvement in the overall population. However, a significant survival advantage for BMDex was observed in patients without severe (New York Heart Association class III or IV) heart failure and with N-terminal pro-natriuretic peptide type-B <8500 ng/l. Patients treated with full-dose dexamethasone had similar response rates and survival whether they received bortezomib or not. Intermediate-risk patients who are not fit enough to receive high-dose dexamethasone are likely to take the greatest advantage from the addition of bortezomib to MDex.

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Acknowledgements

This work was supported by grants from ‘Associazione Italiana per la Ricerca sul Cancro’ Special Program Molecular Clinical Oncology 5 per mille n. 9965 ‘Harnessing tumor cell/microenvironment cross talk to treat mature B cell tumors, and from Cariplo Foundation (n. 2013-0964).

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Authors and Affiliations

  1. Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy,

    G Palladini, P Milani, A Foli, M Vidus Rosin, M Basset, F Lavatelli, M Nuvolone, L Obici & G Merlini

  2. Department of Molecular Medicine, University of Pavia, Pavia, Italy,

    G Palladini, P Milani, A Foli, M Vidus Rosin, M Basset, M Nuvolone, L Obici & G Merlini

  3. Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy,

    P Milani & S Perlini

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  1. G Palladini
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  2. P Milani
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Correspondence to G Merlini.

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Competing interests

GM received honoraria from Millennium Takeda. The remaining authors declare no conflict of interest.

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Palladini, G., Milani, P., Foli, A. et al. Melphalan and dexamethasone with or without bortezomib in newly diagnosed AL amyloidosis: a matched case–control study on 174 patients. Leukemia 28, 2311–2316 (2014). https://doi.org/10.1038/leu.2014.227

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