Abstract
Light chain (AL) amyloidosis is the result of a clonal plasma cell expansion, in which amyloidogenic monoclonal light chains deposit in various tissues resulting in organ dysfunction and organ failure. The median survival of patients with AL amyloidosis without therapy is 10–14 months. Several phase II studies report haematological and clinical remission in up to 50% of patients after high-dose melphalan and autologous stem cell transplantation. We analysed retrospectively the long-term outcome of 19 patients treated in this way between August/1996 and December/2001. We observed a relatively high treatment-related mortality of 26%, but 12 patients (63%) were high-risk candidates. Eight patients (42%) surviving longer than 100 days achieved haematological remission and long-term survival, whereas 6 (32%) obtained no clear benefit from high-dose therapy. However, 62% of patients survived beyond 2 years and the median survival from transplant was 48 months (range 0–104 months).
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, Linos A, Mary Beard C, Linke RP, Gertz MA, O'Fallon M et al. Incidence and natural history of primary systemic amyloidosis (AL) in Olmsted Country, Minnesota: 1950–1989. Blood 1992; 79: 1817–1822.
Falk RH, Comenzo RL, Skinner M . The systemic amyloidosis. N Engl J Med 1997; 337: 898–909.
Kyle RA, Gertz MA, Greipp PR, Witzig TE, Lust JA, Lacy MQ et al. Long-term survival (10 years or more) in 30 patients with primary amyloidosis. Blood 1999; 93: 1062–1066.
Skinner M, Anderson JJ, Simms R . Treatment of 100 patients with primary amyloidosis: a randomized trial of melphalan, prednisone and colchicine versus colchicine only. Am J Med 1996; 100: 290–298.
Kyle RA, Gertz MA, Greipp PR, Witzig TE, Lust JA, Lacy MQ et al. A trial of three regimens for primary amyloidosis: colchicine alone, melphalan and prednisone, and melphalan, prednisone and colchicine. N Engl J Med 1997; 336: 1202–1207.
Gertz MA, Lacy MQ, Lust JA, Greipp PP, Witzig TE, Kyle RA . Prospective randomized trial of melphalan and prednisone versus vincristine, carmustine, melphalan, cyclophosphamide, and prednisone in the treatment of primary systemic amyloidosis. J Clin Oncol 1999; 17: 262–267.
Palladini G, Perfetti V, Obici L, Caccialanza R, Semino A, Adami F et al. Association of melphalan and high-dose dexamethasone is effective and well tolerated in patients with AL (primary) amyloidosis who are ineligible for stem cell transplantation. Blood 2004; 103: 2936–2938.
Goodman HJB, Hawkins PN . The role of PBSCT in treatment of AL amyloidosis is far from settled. Blood 2004; 104: 2991.
Comenzo RL, Vosburgh E, Falk RH, Sanchorawala V, Reisinger J, Dubrey S et al. Dose-intensive melphalan with blood stem-cell support for the treatment of AL (amyloid light-chain) amyloidosis: survival and responses in 25 patients. Blood 1998; 91: 3662–3670.
Gillmore JD, Apperley JF, Craddock C . High-dose melphalan and stem cell recue for AL amyloidosis. In: Kyle RA, Gertz MA (eds). Amyloid and amyloidosis. Parthenon Publishing Group: New York & London, 1998, pp 102–104.
Comenzo RL, Gertz MA . Autologous stem cell transplantation for primary systemic amyloidosis. Blood 2002; 99: 4276–4282.
Gertz M, Lacy M, Gastineau DA, Inwards DJ, Chen MG, Teffei A et al. Blood stem cell transplantation as therapy for primary systemic amyloidosis. Bone Marrow Transplantation 2000; 26: 963–969.
Gertz MA, Lacy MQ, Dispenzieri A, Gastineau DA, Chen MG, Ansell SM et al. Stem cell transplantation for the management of primary systemic amyloidosis. Am J Med 2002; 113: 549–555.
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.
Jaccard A, Moreau P, Leblond V, Leleu X, Bebboubker L, Hermine O et al. Autologous stem cell transplantation (ASCT) versus oral melphalan and high-dose dexamethasone in patients with AL (Primary) amyloidosis: results of the French multicentric randomized trial (MAG and IFM Intergroup). Blood 2005; 106 (Suppl) Abstract 421.
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 transplant: a case control study. Blood 2004; 103: 3960–3963.
Hawkins PN, Lavender JP, Pepys MB . Evaluation of systemic amyloidosis by scintigraphy with I123-labeled serum amyloid P component. N Engl J Med 1990; 323: 542–543.
Linke RP . Highly sensitive diagnosis of amyloid and variuos amyloid syndromes using congo red fluorescence. Virchow Arch Path Anat 2000; 436: 439–448.
Blade J, Samson D, Reece D, Apperley J, Bjorkstrand B, Gahrton G et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol 1998; 102: 1115–1123.
Gertz MA, Comenzo R, Falk RH, Fermand JP, Hazenberg BP, Hawkins PN et al. Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis, Tours, France, 18–22 April 2004. Am J Hematol 2005; 79: 319–328.
Sanchorawala V, Wright DG, Seldin DC, Falk RH, Finn KT, Dember LM et al. High-dose intravenous melphalan and autologous stem cell transplantation as initial therapy or following two cycles of oral chemotherapy for the treatment of AL amyloidosis: results of a prospective randomized trial. Bone Marrow Transplant 2004; 33: 381–388.
Perz JB, Schonland SO, Hundemer M, Kristen AV, Dengler TJ, Zeier M et al. High-dose melphalan with autologous stem cell transplantation after VAD induction chemotherapy for treatment of amyloid light chain myloidosis: a single centre prospective phase II study. Br J Haematol 2004; 127: 543–551.
Perz JB, Schonland SO, Hundemer M, Zeier M, Linke RP, Ho AD et al. High-dose melphalan and stem cell recue for kidney AL amyloidosis. In: Grateau G, Kyle RA, Skinner M (eds). Amyloid and amyloidosis. CRC Press: Boca Raton, FL, 2005, pp 118–120.
Moreau P, Leblond V, Baurquelot P . Prognostic factors of survival and response after high-dose therapy and autologous stem cell transplantation in systemic AL myloidosis: a report on 21 patients. Br J Haematol 1998; 101: 766–769.
Acknowledgements
We especially thank our colleagues from the Department of Cardiology and the Department of Nephrology at the Hammersmith Hospital for excellent interdisciplinary co-operation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Perz, J., Rahemtulla, A., Giles, C. et al. Long-term outcome of high-dose melphalan and autologous stem cell transplantation for AL amyloidosis. Bone Marrow Transplant 37, 937–943 (2006). https://doi.org/10.1038/sj.bmt.1705354
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1705354
Keywords
This article is cited by
-
Early intensification and autologous stem cell transplantation in patients with systemic AL amyloidosis: a single-centre experience
Annals of Hematology (2009)
-
52-jähriger Patient mit schwerer Herzinsuffizienz bei multiplem Myelom
Der Internist (2009)
-
Multiple myeloma-associated AL amyloidosis: is a distinctive therapeutic approach warranted?
Bone Marrow Transplantation (2006)