Autologous stem cell transplantation in patients with AL amyloidosis with impaired renal function

Abstract

We retrospectively reviewed the impact of impaired renal function (eGFR < 45 ml/min/SA) on post-transplant outcomes in patients receiving ASCT for AL amyloidosis. Patients were grouped into two cohorts, those with normal renal function (NRF) eGFR ≥ 45 ml/min (n = 568) and those with impaired renal function (IRF) eGFR < 45 ml/min (n = 87). Patients with IRF had higher renal stage (>Stage 1: 100% IRF vs 37% NRF, p < 0.0001) and the majority received conditioning with melphalan <200 mg/m2 (70% IRF vs 21% NRF, p < 0.0001). Forty-four patients (6.7%) required dialysis within 100 days of ASCT. Renal stage predicted for dialysis institution within 100 days of ASCT (3% Stage I vs 10% Stage II vs 22% Stage III, p < 0.0001). Dialysis within 100 days was higher in the IRF cohort (16% for IRF cohort vs 6% for NRF cohort, p = 0.0007. Patients with impaired renal function were more likely to be admitted to hospital (80% IRF vs 70% NRF, p = 0.03). The 100-day mortality was higher in the IRF cohort (14% IRF cohort vs 5% NRF cohort, p = 0.008). Median OS and PFS were similar between the two cohorts. Impaired renal function predicts for a higher rate of hospitalization, progression to dialysis and early mortality in patients receiving ASCT for AL amyloidosis.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Merlini G, Dispenzieri A, Sanchorawala V, Schonland SO, Palladini G, Hawkins PN. et al. Systemic immunoglobulin light chain amyloidosis. Nat Rev Dis Primers. 2018;4:38.

  2. 2.

    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;124:2325–32.

  3. 3.

    Havasi A, Stern L, Lo S, Sun F, Sanchorawala V. Validation of new renal staging system in AL amyloidosis treated with high dose melphalan and stem cell transplantation. Am J Hematol. 2016;91:E458–460.

  4. 4.

    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;79:319–28.

  5. 5.

    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;30:4541–9.

  6. 6.

    Kumar S, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Colby C, et al. Revised prognostic staging system for light chain amyloidosis incorporating cardiac biomarkers and serum free light chain measurements. J Clin Oncol. 2012;30:989–95.

  7. 7.

    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;22:3751–7.

  8. 8.

    Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Kumar SK, Dingli D, et al. Autologous stem cell transplant for immunoglobulin light chain amyloidosis: a status report. Leuk Lymphoma. 2010;51:2181–7.

  9. 9.

    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;26:2317–25.

  10. 10.

    Moreau P, Leblond V, Bourquelot P, Facon T, Huynh A, Caillot D, et al. Prognostic factors for survival and response after high-dose therapy and autologous stem cell transplantation in systemic AL amyloidosis: a report on 21 patients. Br J Haematol. 1998;101:766–9.

  11. 11.

    Jaccard A, Moreau P, Leblond V, Leleu X, Benboubker L, Hermine O, et al. High-dose melphalan versus melphalan plus dexamethasone for AL amyloidosis. N Engl J Med. 2007;357:1083–93.

  12. 12.

    Sidiqi MH, Aljama MA, Buadi FK, Warsame RM, Lacy MQ, Dispenzieri A, et al. Stem cell transplantation for light chain amyloidosis: decreased early mortality over Time. J Clin Oncol. 2018;36:1323–9.

  13. 13.

    D’Souza A, Dispenzieri A, Wirk B, Zhang MJ, Huang J, Gertz MA, et al. Improved outcomes after autologous hematopoietic cell transplantation for light chain amyloidosis: A Center for International Blood and Marrow Transplant Research Study. J Clin Oncol. 2015;33:3741–9.

  14. 14.

    Gertz M, Lacy M, Dispenzieri A, Hayman S, Kumar S, Buadi F, et al. Troponin T level as an exclusion criterion for stem cell transplantation in light-chain amyloidosis. Leuk Lymphoma. 2008;49:36–41.

  15. 15.

    Lee SY, Meehan RS, Seldin DC, Sloan JM, Quillen K, Shelton A, et al. Effect of severe hypoalbuminemia on toxicity of high-dose melphalan and autologous stem cell transplantation in patients with AL amyloidosis. Bone Marrow Transplant. 2016;51:1318–22.

Download references

Author information

Correspondence to Morie A. Gertz.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark