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Multiple myeloma gammopathies

Prognostic restaging at the time of second-line therapy in patients with AL amyloidosis

Leukemia volume 33, pages 1268–1272 (2019)Cite this article

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Abstract

It is well known that staging of patients with AL amyloidosis at diagnosis predicts for survival, but there is a paucity of literature delineating the prognostic value of these systems at relapse. We evaluated the prognostic value of AL staging among 413 patients initiated with second-line therapy between 2000 and 2015. Both the Revised Mayo 2012 and the European revision of Mayo 2004 staging systems were used. The median time from initial treatment to second-line therapy was 11.7 months. The first-line therapy was autologous stem cell transplant (ASCT) in 179 (43%) patients and non-ASCT therapies in 234 patients. Median survival from the institution of second-line therapy was 61 months. Both the Mayo 2004 and 2012 staging systems were of prognostic benefit at second-line therapy with respective risk ratios of 2.78 (95% CI: 2.15, 3.58) and 3.03 (95% CI: 2.33, 3.93) for patients with > stage 2 disease. On multivariate analysis, the predictive value of staging at second-line therapy was independent of stage at diagnosis and prior ASCT as first-line therapy. This study indicates that the Mayo staging systems work well at second-line therapy. Consequently, it is suitable for the stratification of patients in trials for relapsed, refractory AL amyloidosis.

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Acknowledgements

We thank the Predolin Foundation, the JABBS Foundation, and the support from the SPORE grant (no. CA 186781) to our work.

Author contributions

Conception and design: Yi L Hwa and Angela Dispenzieri. Provision of study materials of patients: all authors. Data analysis and interpretation: Yi L Hwa and Angela Dispenzieri. Manuscript writing: all authors. Final approval of manuscript: all authors.

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Authors and Affiliations

  1. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    Yi L. Hwa, Morie A. Gertz, Shaji K. Kumar, Martha Q. Lacy, Francis K. Buadi, David Dingli, Prashant Kapoor, Steve R. Zeldenrust, Nelson Leung, Susanne R. Hayman, Wilson I. Gonsalves, Taxiarchis V. Kourelis, Rahma Warsame, Ronald S. Go, Eli Muchtar, Miriam A. Hobbs, Amie L. Fonder, Stephen Russell, Robert A. Kyle, S. Vincent Rajkumar & Angela Dispenzieri

  2. Divsion of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA

    Nelson Leung

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Correspondence to Angela Dispenzieri.

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Conflict of interest

AD: received research funding from Jannsen, Takeda, Celgene, Pfizer, Alnylam, Prothena, and GSK, and serves on the advisory board of Takeda and Intellia. MAG: received funding from Amgen, Prothena, Annexon, Appellis, Johnson and Johnson, and Celgene consultancy (Milleniu), and honoraria from Celgene, Millenium, Onyx, Novartis, Smith Kline, Prothena, and Ionis. SK: received research grants for clinical trials from Celgene, Takeda, Janssen, BMS, Sanofi, KITE, Merck, Abbvie, Medimmune, Novartis, Roche-Genentech, and Amgen. DD: received research funding from Karyopharm Therapeutics, Amgen, and Millenium Pharmaceuticals. NL: serves on the advisory board of Takeda and Prothena. PK: receives funding from Takeda, Sanofi, and Amgen. MQL: received research funding from Celgene. The remaining authors declare no conflict of interest.

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Hwa, Y.L., Gertz, M.A., Kumar, S.K. et al. Prognostic restaging at the time of second-line therapy in patients with AL amyloidosis. Leukemia 33, 1268–1272 (2019). https://doi.org/10.1038/s41375-019-0400-5

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