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Risk factors, treatments and outcomes of patients with light chain amyloidosis who relapse after autologous stem cell transplantation

Bone Marrow Transplantation volume 59, pages 350–358 (2024)Cite this article

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Abstract

Relapse after ASCT is an important factor affecting the long-term prognosis of patients with AL amyloidosis. However, the risk factors of relapse are unknown and there are limited studies on treatment outcomes of these patients. We retrospectively reviewed 170 patients with AL amyloidosis who underwent ASCT between 2010 and 2021. Seventy-six patients confirmed as relapse and the median time from ASCT to relapse was 39 months. On multivariate analysis of variables before and after ASCT, lambda restricted, dFLC >30 mg/L pre ASCT, reduced dose melphalan and dFLC >10 mg/L at 6 months after ASCT were independent risk factors for relapse, and achieving CR after induction therapy and renal response after ASCT were protective factors. Most relapsed patients were treated with bortezomib-based regimens (50%) followed by daratumumab-based regimens (22.2%) and other chemotherapy regimens (13.9%). The overall hematological response in evaluable patients was 68.2% with 56.8% achieving CR/VGPR. The median PFS and OS from post-transplant relapse were 25 months and 81 months, respectively. Patients receiving bortezomib or daratumumab showed a better survival compared to other chemotherapy regimens. In conclusion, this study identified independent risk factors of post-transplant relapse and demonstrated the superiority of bortezomib or daratumumab treatment for these patients.

Clinical trial registration

NCT04210791.

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Fig. 1: Survival of the whole cohort and relapsed patients.
Fig. 2: Impact of risk or protective factors in multivariate analysis on relapse.
Fig. 3: Hematological response in evaluable patients by the regimen received.

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Data availability

The data are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank all members of the National Clinical Research Center of Kidney Diseases, Jinling Hospital for caring for AL amyloidosis patients and helping to extract data. This research was supported by the National Natural Science Foundation of China (82270767).

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Authors and Affiliations

  1. Southeast University School of Medicine, Nanjing, 210009, China

    Yuanyuan Zhang & Xianghua Huang

  2. National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China

    Jinzhou Guo, Wencui Chen, Liang Zhao & Xianghua Huang

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Contributions

YYZ and XHH designed the study, collected and analyzed the data, and wrote manuscript. JZG, WCC and LZ managed patients and revised the manuscript critically. All authors reviewed and approved the final version of the manuscript.

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Correspondence to Xianghua Huang.

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The authors declare no competing interests.

Ethics approval statement and patient consent statement

The study was approved by ethics committees of Jinling Hospital and was conducted according to the Declaration of Helsinki. All patients in this study have signed an informed consent form for the use of clinical data for research purposes.

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Zhang, Y., Guo, J., Chen, W. et al. Risk factors, treatments and outcomes of patients with light chain amyloidosis who relapse after autologous stem cell transplantation. Bone Marrow Transplant 59, 350–358 (2024). https://doi.org/10.1038/s41409-023-02185-z

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