Summary:
Serum free light-chain (FLC) concentrations were measured by a sensitive nephelometric immunoassay in 66 patients with AL amyloidosis before and after treatment with high-dose melphalan and autologous stem cell transplantation (HDM/SCT). At 1 year after HDM/SCT, 27 patients (41%) achieved a complete hematologic response (CR), that is, disappearance of the monoclonal gammopathy previously evident by immunofixation electrophoresis (IFE) in serum and urine and of plasma cell clonality in the bone marrow. Abnormally elevated FLC levels became normal in 27 patients (41%), and decreased by >90% in 37 (56%). Average improvements in FLC were 94% for patients who achieved a CR and 72% for those who did not (P=0.0001). However, a reduction in FLC of >90% was associated with a similar high likelihood of clinical improvement and prolonged survival, whether or not patients achieved a CR. While CR, as defined by standard criteria, is a more stringent indicator of hematologic response than are decreases in abnormally elevated FLC levels per se, these measures of hematologic response are complementary, and decreases in FLC are more readily detected early after treatment than are the changes in IFE and marrow studies required to determine CR.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Kyle RA, Gertz MA . Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol 1995; 8: 45–59.
Keren DF . Procedures for the evaluation of monoclonal immunoglobulins. Arch Pathol Lab Med 1999; 123: 126–132.
Sanchorawala V, Wright DG, Seldin DC et al. An overview of high-dose melphalan with autologous stem cell transplantation for the treatment of AL amyloidosis. Bone Marrow Transplant 2001; 28: 637–642.
Skinner M, Sanchorawala V, Seldin DC et al. High-dose melphalan and autologous stem cell transplantation in patient with AL amyloidosis: An 8 year study. Ann Int Med 2004; 140: 85–93.
Dispenzieri A, Kyle RA, Lacy MQ et al. Superior survival in primary systemic amyloidosis patients undergoing peripheral blood stem cell transplantation: a case–control study. Blood 2004; 103: 3960–3963.
Seldin D, Anderson J, Sanchorawala V et al. Improvement in quality of life of patient with AL amyloidosis treated with high-dose melphalan and autologous stem cell transplantation. Blood 2004; 104: 1888–1893.
Blade J, Samson D, Reece D et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haematopoietic stem cell transplantation. Br J Haematol 1998; 102: 1115–1123.
Bradwell AR, Carr-Smith HD, Mead GP et al. Highly sensitive, automated immunoassay for immunoglobulin free light chains in serum and urine. Clin Chem 2001; 47: 673–680.
Lachmann HJ, Gallimore R, Gillmore JD et al. Outcome in systemic AL amyloidosis in relation to changes in concentration of circulating free immunoglobulin light chains following chemotherapy. Br J Haematol 2003; 122: 78–84.
Acknowledgements
This work was supported by grants from the National Institutes of Health (HL 68705), Food and Drug Administration (FD-R-001346), and the Amyloid Research Fund at Boston University. DCS is a Scholar of the Leukemia and Lymphoma Society of America.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sanchorawala, V., Seldin, D., Magnani, B. et al. Serum free light-chain responses after high-dose intravenous melphalan and autologous stem cell transplantation for AL (primary) amyloidosis. Bone Marrow Transplant 36, 597–600 (2005). https://doi.org/10.1038/sj.bmt.1705106
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1705106
Keywords
This article is cited by
-
Systemic Amyloidosis: a Contemporary Overview
Clinical Reviews in Allergy & Immunology (2020)
-
Optimizing deep response assessment for AL amyloidosis using involved free light chain level at end of therapy: failure of the serum free light chain ratio
Leukemia (2019)
-
Auto-SCT improves survival in systemic light chain amyloidosis: a retrospective analysis with 14-year follow-up
Bone Marrow Transplantation (2014)
-
Safety and efficacy of high-dose melphalan and auto-SCT in patients with AL amyloidosis and cardiac involvement
Bone Marrow Transplantation (2014)
-
Bortezomib and dexamethasone consolidation following risk-adapted melphalan and stem cell transplantation for patients with newly diagnosed light-chain amyloidosis
Leukemia (2013)