Predictors of early treatment failure following initial therapy for systemic immunoglobulin light-chain amyloidosis. (3rd July 2017)

• Record Type: Journal Article
• Authors: Tandon, Nidhi; Sidana, Surbhi; Rajkumar, S. Vincent; Dispenzieri, Angela; Gertz, Morie A.; Lacy, Martha Q.; Kyle, Robert A.; Buadi, Francis K.; Dingli, David; Hayman, Suzanne R.; Fonder, Amie L.; Hobbs, Miriam A.; Gonsalves, Wilson I.; Kapoor, Prashant; Hwa, Yi Lisa; Leung, Nelson; Go, Ronald S.; Lust, John A.; Russell, Stephen J.; Zeldenrust, Steven R.; Kumar, Shaji K.
• Is Part Of: Amyloid. Volume 24:Number 3(2017)
• Page Start: 183
• Page End: 188
• Publication Date: 2017-07-03
• Subjects: Predictors -- relapse -- amyloidosis -- refractory -- early death; Amyloidosis -- Periodicals; 616.3995
• DOI: 10.1080/13506129.2017.1351354
• Languages: English
• ISSNs: 1350-6129

Abstract

Abstract: We analysed factors predicting early treatment failure (ETF), after first-line therapy for light-chain amyloidosis (AL). AL amyloidosis patients seen at Mayo Clinic within 90 days of diagnosis, from 2006 to 2015, excluding those who died within 3 months of initial therapy, were analysed retrospectively. ETF was defined as progression requiring treatment change or death within 12 (ETF12) or 24 (ETF24) months of first-line treatment. Non-ETF included those with a follow-up of more than 12 or 24 months who had progression beyond 12 or 24 months. A total of 724 patients met the study criteria; 244 (33.7%) had ETF12 and 388 (53.6%) had ETF24. Patients with ETF12 were older (64.1 vs. 62.2 years) with higher prevalence of cardiac (81 vs. 64.1%) and multi-organ involvement (67.2 vs. 45.4%) and higher proportion of patients with t(11; 14) (58.5 vs. 44.3%) or in higher Mayo 2012 stage (58.5 vs. 41.1%).The median follow-up was 5.4 years from start of initial therapy. In multivariate analysis, presence of t(11; 14) and non-incorporation of autologous transplant in initial therapy are significant predictors of ETF12 ( p = .01and p = .003) and ETF24 ( p = .0001 and p = .005) while Mayo stage is predictive of ETF24 ( p = .002), but not ETF12.