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Plasma Cell Disorders

Bortezomib-based induction for transplant ineligible AL amyloidosis and feasibility of later transplantation

Bone Marrow Transplantation volume 50, pages 914–917 (2015)Cite this article

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Abstract

Recent studies support the use of bortezomib-based therapies in light chain amyloidosis (AL). We performed a retrospective analysis of the safety, efficacy and long-term survival (median follow-up 3 years) after bortezomib-based treatment in 28 consecutive patients with de novo AL deemed ineligible at initial presentation. The first 14 patients received bortezomib and dexamethasone (VD), and the second 14 patients received cyclophosphamide, bortezomib and dexamethasone (CVD; CyBorD). Both regimens were well tolerated with no treatment-related mortality. The overall hematological response (HR) rate was 93% in both the groups. Median time to response was shorter in the CVD group (39 days vs 96 days in the VD group; P=0.002). Hematological and organ responses induced with bortezomib-based therapy enabled 8 (33%) of initially transplant ineligible patients to undergo autologous hematopoietic stem cell transplantation (AHCT), including 4 patients with cardiac stage III or IV. Seven of the eight patients (88%) who underwent subsequent AHCT achieved sustained HR at a median of 33 months posttransplant. These data suggest that bortezomib-based induction followed by AHCT is a viable therapeutic strategy for transplant-ineligible AL. Larger, multicenter prospective trials are necessary to confirm our findings.

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Authors and Affiliations

  1. Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA

    R F Cornell

  2. Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA

    X Zhong

  3. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    C Arce-Lara, E Atallah, L Blust, W R Drobyski, T S Fenske, M C Pasquini, J D Rizzo, W Saber & P N Hari

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  1. R F Cornell
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  4. E Atallah
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  5. L Blust
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  6. W R Drobyski
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  8. M C Pasquini
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  10. W Saber
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  11. P N Hari
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Correspondence to R F Cornell.

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The authors declare no conflict of interest.

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Author contributions

RFC collected and analyzed data and wrote the manuscript; XZ performed the statistical analysis; and PH designed the treatment protocols, generated the clinical data, analyzed and wrote the manuscript. CA, EA, LB, WD, TF, MP, JDR and WS enrolled patients and wrote the manuscript.

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Cornell, R., Zhong, X., Arce-Lara, C. et al. Bortezomib-based induction for transplant ineligible AL amyloidosis and feasibility of later transplantation. Bone Marrow Transplant 50, 914–917 (2015). https://doi.org/10.1038/bmt.2015.73

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