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Improving security of autologous hematopoietic stem cell transplant in patients with light-chain amyloidosis

Bone Marrow Transplantation volume 54, pages 1295–1303 (2019)Cite this article

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Abstract

Autologous stem cell transplant (ASCT) has demonstrated to be an effective treatment for patients with light-chain (AL) amyloidosis. However, a high transplant-related mortality (TRM) rate was reported in previous series of patients and questioned the role of transplant in this disease. Recently, experienced groups have shown a significant TRM decrease that has been attributed to an accurate selection of patients. Moreover, application of several supportive measures has decreased toxicity over amyloid-involved organs. We analyzed a series of 66 patients with AL amyloidosis, who underwent ASCT at a single institution and evaluated the impact of these measures beyond patient selection. Four temporary groups were established: group-A (non-selection plus post-transplant G-CSF use) with 29 patients, group-B (selection) with 13, group-C (selection and G-CSF avoidance) with 14, and group-D (selection, G-CSF avoidance and corticosteroid’s prophylaxis) with 10. A decreasing TRM was observed over time from group-A (38%), to group-D (0%); p = 0.02. We also observed a progressive increase of three-year OS from 62% in group-A to 100% in group-D; p = 0.049. On the multivariate analysis, cardiac involvement was the only independent predictor of survival. Therefore, tailored selection policy together with transplant supportive measures have allowed ASCT to be a safe procedure in AL amyloidosis.

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Acknowledgements

This work has been supported in part by grants PI12/01290 and PI16/0423 from Instituto de Salud Carlos III and Fondo Europeo de Desarrollo Regional (FEDER), and 2017SGR-792 from AGAUR (Generalitat de Catalunya).

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Author notes

  1. These authors contributed equally: Gonzalo Gutiérrez-García, María Teresa Cibeira

Authors and Affiliations

  1. Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain

    Gonzalo Gutiérrez-García, Montserrat Rovira, Luis Gerardo Rodríguez-Lobato, Laura Rosiñol, Pedro Marín, Julio Solano-Vega, María Suárez-Lledó, Alex Bataller, María Teresa Solano, Noemí de Llobet, Ariadna Domenech, Nuria Borràs, Carmen Martínez, Álvaro Urbano-Ispizua, Jordi Esteve & Francesc Fernández-Avilés

  2. Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain

    Gonzalo Gutiérrez-García, María Teresa Cibeira, Montserrat Rovira, Carlos Fernández de Larrea, Natalia Tovar, Luis Gerardo Rodríguez-Lobato, Laura Rosiñol, Pedro Marín, María Suárez-Lledó, Alex Bataller, María Teresa Solano, Carmen Martínez, Álvaro Urbano-Ispizua, Jordi Esteve, Francesc Fernández-Avilés & Joan Bladé

  3. Department of Hemotherapy and Hemostasis, Hospital Clínic of Barcelona, Barcelona, Spain

    Gonzalo Gutiérrez-García, María Teresa Cibeira, Montserrat Rovira, Carlos Fernández de Larrea, Natalia Tovar, Luis Gerardo Rodríguez-Lobato, Laura Rosiñol, Pedro Marín, María Suárez-Lledó, Alex Bataller, María Teresa Solano, Miquel Lozano, Joan Cid, Carmen Martínez, Álvaro Urbano-Ispizua, Jordi Esteve, Francesc Fernández-Avilés & Joan Bladé

  4. University of Barcelona, Barcelona, Spain

    Gonzalo Gutiérrez-García, María Teresa Cibeira, Montserrat Rovira, Carlos Fernández de Larrea, Natalia Tovar, Luis Gerardo Rodríguez-Lobato, Laura Rosiñol, Pedro Marín, María Suárez-Lledó, Alex Bataller, María Teresa Solano, Miquel Lozano, Joan Cid, Carmen Martínez, Álvaro Urbano-Ispizua, Jordi Esteve, Francesc Fernández-Avilés & Joan Bladé

  5. Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain

    Gonzalo Gutiérrez-García, María Teresa Cibeira, Montserrat Rovira, Carlos Fernández de Larrea, Natalia Tovar, Luis Gerardo Rodríguez-Lobato, Laura Rosiñol, Pedro Marín, María Suárez-Lledó, Alex Bataller, María Teresa Solano, Miquel Lozano, Joan Cid, Carmen Martínez, Álvaro Urbano-Ispizua, Jordi Esteve, Francesc Fernández-Avilés & Joan Bladé

  6. Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain

    Enric Carreras

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  1. Gonzalo Gutiérrez-García
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Correspondence to Gonzalo Gutiérrez-García.

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Conflict of interest

Gonzalo Gutiérrez-García: honoraria from Gilead. María Teresa Cibeira: honoraria from Janssen, Celgene, and Amgen. Carlos Fernández de Larrea: honoraria from Janssen, Celgene, and Amgen; advisory boards: Janssen, Celgene, and Amgen; grants from: Janssen, Celgene, Amgen, and Takeda. Laura Rosiñol: honoraria from Janssen, Celgene, Amgen, and Takeda. The remaining authors declare that they have no conflict of interest.

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Gutiérrez-García, G., Cibeira, M.T., Rovira, M. et al. Improving security of autologous hematopoietic stem cell transplant in patients with light-chain amyloidosis. Bone Marrow Transplant 54, 1295–1303 (2019). https://doi.org/10.1038/s41409-019-0447-y

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