Outcome of AL amyloidosis after high-dose melphalan and autologous stem cell transplantation in Sweden, long-term results from all patients treated in 1994-2009
2016 (English)In: BONE MARROW TRANSPLANTATION, ISSN 0268-3369, Vol. 51, no 12, 1569-1572 p.Article in journal (Refereed) Published
High-dose melphalan and autologous stem cell transplantation (HDM/ASCT) is widely used in immunoglobulin light chain (AL) amyloidosis, but the benefit is debated mainly because of the high treatment-related mortality (24% in a randomised study comparing HDM/ASCT with oral melphalan/dexamethasone). We report here on the long-term outcome of all patients treated with HDM/ASCT for AL amyloidosis in Sweden between 1994 and 2009. Seventy-two patients were treated at eight Swedish centres. Median follow-up was 67.5 months. At least partial response (organ or haematological) was seen in 64% of the patients. Median overall survival was 98 months or 8.2 years, with 5-year survival 63.9% and 10-year survival 43.4%. In patients with cardiac involvement or multiple organ involvement, survival was significantly shorter, median overall survival 49 and 56 months, respectively. All mortality within 100 days from ASCT was 12.5% for all patients and 17.2% in the patients with cardiac involvement. For patients treated in the earlier time period (1994-2001), 100-day mortality was 23.8% compared with 7.8% in the later period (2002-2009). In conclusion, long survival times can be achieved in patients with AL amyloidosis treated with HDM/ ASCT, also in smaller centres. Early mortality is high, but with a decreasing trend over time.
Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP , 2016. Vol. 51, no 12, 1569-1572 p.
IdentifiersURN: urn:nbn:se:liu:diva-134214DOI: 10.1038/bmt.2016.249ISI: 000390759600005PubMedID: 27694943OAI: oai:DiVA.org:liu-134214DiVA: diva2:1069819