Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Outcomes of autologous hematopoietic cell transplantation in primary amyloidosis after bortezomib-based induction therapy

Bone Marrow Transplantation volume 51, pages 732–734 (2016)Cite this article

Subjects

The treatment of amyloidosis often involves autologous hematopoietic cell transplantation (AHCT) following high-dose melphalan.1, 2 There has been an increasing interest in using induction chemotherapy to cyto-reduce and achieve good hematologic and organ responses prior to AHCT in amyloidosis.3, 4 Bortezomib is a proteasome inhibitor with activity in plasma cell disorders that has been reported to achieve high rates of hematologic and organ response in amyloidosis.5, 6 Treatment with bortezomib pre-AHCT has been shown to improve transplant eligibility for patients, previously considered to be too high risk for AHCT, and may increase the response rates following AHCT.7, 8, 9, 10 Herein, we describe our experience using bortezomib prior to AHCT and demonstrate the feasibility of this approach.

Twenty-four consecutive patients with primary amyloidosis underwent AHCT between June 2007 and March 2014 at our institution. Among these, 20 received induction therapy with a bortezomib-based regimen prior to transplantation. Data for these patients were obtained from our Institutional Unified Transplant Database, that prospectively collects disease and outcome data for hematopoietic cell transplantation recipients. Data were supplemented from a chart review of our institutional electronic medical records. The study was approved by the Cleveland Clinic’s Institutional Review Board.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Cibeira MT, Sanchorawala V, Seldin DC, Quillen K, Berk JL, Dember LM et al. Outcome of AL amyloidosis after high-dose melphalan and autologous stem cell transplantation: long-term results in a series of 421 patients. Blood 2011; 118: 4346–4352.

    Article  CAS  Google Scholar 

  2. Kyle RA, Gertz MA . Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol 1995; 32: 45–59.

    CAS  Google Scholar 

  3. Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Kumar SK, Leung N et al. Effect of hematologic response on outcome of patients undergoing transplantation for primary amyloidosis: importance of achieving a complete response. Haematologica 2007; 92: 1415–1418.

    Article  Google Scholar 

  4. Schonland SO, Dreger P, de Witte T, Hegenbart U . Current status of hematopoietic cell transplantation in the treatment of systemic amyloid light-chain amyloidosis. Bone Marrow Transplant 2012; 47: 895–905.

    Article  CAS  Google Scholar 

  5. Palladini G, Sachchithanantham S, Milani P, Gillmore J, Foli A, Lachmann H et al. A European collaborative study of cyclophosphamide, bortezomib, and dexamethasone in upfront treatment of systemic AL amyloidosis. Blood 2015; 126: 612–615.

    Article  CAS  Google Scholar 

  6. Sanchorawala V, Brauneis D, Shelton AC, Lo S, Sun F, Sloan JM et al. Induction Therapy with Bortezomib Followed by Bortezomib-High Dose Melphalan and Stem Cell Transplantation for Light Chain Amyloidosis: Results of a Prospective Clinical Trial. Biol Blood Marrow Transplant 2015; 21: 1445–1451.

    Article  CAS  Google Scholar 

  7. Palladini G, Dispenzieri A, Gertz MA, Kumar S, Wechalekar A, Hawkins PN et al. New criteria for response to treatment in immunoglobulin light chain amyloidosis based on free light chain measurement and cardiac biomarkers: impact on survival outcomes. J Clin Oncol 2012; 30: 4541–4549.

    Article  CAS  Google Scholar 

  8. Cornell RF, Zhong X, Arce-Lara C, Atallah E, Blust L, Drobyski WR et al. Bortezomib-based induction for transplant ineligible AL amyloidosis and feasibility of later transplantation. Bone Marrow Transplant 2015; 50: 914–917.

    Article  CAS  Google Scholar 

  9. Scott EC, Heitner SB, Dibb W, Meyers G, Smith SD, Abar F et al. Induction bortezomib in Al amyloidosis followed by high dose melphalan and autologous stem cell transplantation: a single institution retrospective study. Clin Lymphoma Myeloma Leuk 2014; 14: 424–430.e1.

    Article  Google Scholar 

  10. Huang X, Wang Q, Chen W, Zeng C, Chen Z, Gong D et al. Induction therapy with bortezomib and dexamethasone followed by autologous stem cell transplantation versus autologous stem cell transplantation alone in the treatment of renal AL amyloidosis: a randomized controlled trial. BMC Med 2014; 12: 2.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. Dispenzieri A, Gertz MA, Kyle RA, Lacy MQ, Burritt MF, Therneau TM et al. Serum cardiac troponins and N-terminal pro-brain natriuretic peptide: a staging system for primary systemic amyloidosis. J Clin Oncol 2004; 22: 3751–3757.

    Article  CAS  Google Scholar 

  13. Palladini G, Hegenbart U, Milani P, Kimmich C, Foli A, Ho AD et al. A staging system for renal outcome and early markers of renal response to chemotherapy in AL amyloidosis. Blood 2014; 124: 2325–2332.

    Article  CAS  Google Scholar 

  14. Comenzo RL, Reece D, Palladini G, Seldin D, Sanchorawala V, Landau H et al. Consensus guidelines for the conduct and reporting of clinical trials in systemic light-chain amyloidosis. Leukemia 2012; 26: 2317–2325.

    Article  CAS  Google Scholar 

  15. Sanchorawala V, Sun F, Quillen K, Sloan JM, Berk JL, Seldin DC . Long-term outcome of patients with AL amyloidosis treated with high-dose melphalan and stem cell transplantation: 20 year experience. Blood 2015; 126: 2345–2347.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA

    S Hong

  2. Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA

    J Valent, B Bolwell, R Dean, A T Gerds, D Jagadeesh, B K Hamilton, B Hill, M E Kalaycio, B Pohlman, F Reu, C Samaras, R Sobecks, N S Majhail & H D Liu

  3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    L Rybicki

  4. Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    D Abounader, B Bolwell, R Dean, A T Gerds, D Jagadeesh, B K Hamilton, B Hill, M E Kalaycio, B Pohlman, F Reu, C Samaras, R Sobecks, N S Majhail & H D Liu

Authors
  1. S Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J Valent
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L Rybicki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D Abounader
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B Bolwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R Dean
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A T Gerds
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. D Jagadeesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. B K Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. B Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M E Kalaycio
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. B Pohlman
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. F Reu
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. C Samaras
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. R Sobecks
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. N S Majhail
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. H D Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N S Majhail.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hong, S., Valent, J., Rybicki, L. et al. Outcomes of autologous hematopoietic cell transplantation in primary amyloidosis after bortezomib-based induction therapy. Bone Marrow Transplant 51, 732–734 (2016). https://doi.org/10.1038/bmt.2015.326

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2015.326

This article is cited by

Search

Advanced search

Quick links