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Delineation of the timing of second-line therapy post-autologous stem cell transplant in patients with AL amyloidosis.
Hwa, Yi L; Warsame, Rahma; Gertz, Morie A; Buadi, Francis K; Lacy, Martha Q; Kumar, Shaji K; Dingli, David; Zeldenrust, Steve R; Leung, Nelson; Hayman, Susanne R; Kapoor, Prashant; Gonsalves, Wilson I; Kourelis, Taxiarchis V; Russell, Stephen; Go, Ronald S; Hobbs, Miriam A; Fonder, Amie L; Rajkumar, S Vincent; Dispenzieri, Angela.
Afiliação
  • Hwa YL; Division of Hematology.
  • Warsame R; Division of Hematology.
  • Gertz MA; Division of Hematology.
  • Buadi FK; Division of Hematology.
  • Lacy MQ; Division of Hematology.
  • Kumar SK; Division of Hematology.
  • Dingli D; Division of Hematology.
  • Zeldenrust SR; Division of Hematology.
  • Leung N; Division of Hematology.
  • Hayman SR; Division of Nephrology, and.
  • Kapoor P; Division of Hematology.
  • Gonsalves WI; Division of Hematology.
  • Kourelis TV; Division of Hematology.
  • Russell S; Division of Hematology.
  • Go RS; Division of Hematology.
  • Hobbs MA; Division of Hematology.
  • Fonder AL; Division of Hematology.
  • Rajkumar SV; Division of Hematology.
  • Dispenzieri A; Division of Hematology.
Blood ; 130(13): 1578-1584, 2017 09 28.
Article em En | MEDLINE | ID: mdl-28807981
ABSTRACT
Among patients with immunoglobulin light chain (AL) amyloidosis, there is little consensus on when reinstitution of chemotherapy should occur. We conducted a retrospective study to evaluate the patterns of relapse or progression (R/P) and the timing of reinitiating therapy among 235 patients initially treated with autologous stem cell transplant (ASCT) at Mayo Clinic. The median time from ASCT to second-line therapy was 24.3 months. At the time of restarting therapy, median difference of free light chain (dFLC) was 9.9 mg/dL (42% of diagnosis value), 32% had a dFLC <5 mg/dL, and 63% met criteria for organ R/P. The indications for retreatment were (1) clinical suspicion of R/P, 10%; 92) hematologic R/P only, 23%; (3) organ R/P only, 32%; (4) both hematologic and organ R/P, 31%; and (5) suboptimal response to ASCT and second-line therapy as consolidation, 4%. Patients with organ progression at the time of second-line therapy had inferior survival. Although a dFLC of >5 mg/dL at the time of reinstituting therapy was associated with risk, patients relapsing from very good partial response (VGPR) or better had a longer time to develop organ progression after hematologic R/P (24.2 vs 3.2 months, P = .007). These data suggest that the best candidates for clinical trials testing novel plasma cell-directed chemotherapy beyond first line may be those patients who are either relapsing from VGPR or better (dFLC at diagnosis was >5 mg/dL) or having inadequate response to prior therapy. This strategy should allow for hematologic response assessment while avoiding the risk of deleterious organ progression. Implementation of more stringent progression criteria may also be warranted.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Protocolos de Quimioterapia Combinada Antineoplásica / Cadeias Leves de Imunoglobulina / Transplante de Células-Tronco Hematopoéticas / Amiloidose Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2017 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Protocolos de Quimioterapia Combinada Antineoplásica / Cadeias Leves de Imunoglobulina / Transplante de Células-Tronco Hematopoéticas / Amiloidose Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2017 Tipo de documento: Article