Sequential cyclophosphamide-bortezomib-dexamethasone unmasks the harmful cardiac effect of dexamethasone in primary light-chain cardiac amyloidosis. (May 2017)

• Record Type: Journal Article
• Authors: Le Bras, Fabien; Molinier-Frenkel, Valerie; Guellich, Aziz; Dupuis, Jehan; Belhadj, Karim; Guendouz, Soulef; Ayad, Karima; Colombat, Magali; Benhaiem, Nicole; Tissot, Claire Marie; Hulin, Anne; Jaccard, Arnaud; Damy, Thibaud
• Is Part Of: European journal of cancer. Volume 76(2017)
• Page Start: 183
• Page End: 187
• Publication Date: 2017-05
• Subjects: Light-chain (AL) amyloidosis -- Cardiac amyloidosis -- Heart failure -- NT-proBNP -- Free light-chains -- Dexamethasone -- Treatment -- Mortality mortality; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2017.02.004
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Chemotherapy combining cyclophosphamide, bortezomib and dexamethasone is widely used in light-chain amyloidosis. The benefit is limited in patients with cardiac amyloidosis mainly because of adverse cardiac events. Retrospective analysis of our cohort showed that 39 patients died with 42% during the first month. A new escalation-sequential regimen was set to improve the outcomes. Nine newly-diagnosed patients were prospectively treated with close monitoring of serum N-terminal pro-brain natriuretic peptide, troponin-T and free light chains. The results show that corticoids may destabilise the heart through fluid retention. Thus, a sequential protocol may be a promising approach to treat these patients. Highlights: Cardiac involvement in systemic light-chain amyloidosis is frequent and carries poor prognosis. Chemotherapy might destabilise cardiac amyloidosis during the early phase of administration. Dexamethasone might increase fluid retention and arrhythmia leading to cardiac events. Escalation-sequential administration of dexamethasone decrease cardiac-related sudden death.