Depth of response prior to autologous stem cell transplantation to predict survival in light chain amyloidosis.

Authors

null

Iuliana Vaxman

Israel Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel

Iuliana Vaxman , M Hasib Sidiqi , Abdullah S. Al Saleh , Shaji Kumar , Eli Muchtar , Angela Dispenzieri , Francis Buadi , David Dingli , Martha Lacy , Suzanne R. Hayman , Nelson Leung , Wilson I. Gonsalves , Taxiarchis Kourelis , Rahma M. Warsame , William J. Hogan , Morie A. Gertz

Organizations

Israel Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel, Fiona Stanley Hospital, Perth, Austria, Mayo Clinic, Rochester, MN, Mayo Clinic, Division of Hematology, Rochester, MN, Division of Hematology, Mayo Clinic, Rochester, MN

Research Funding

No funding received
None

Background: The role of induction therapy prior to autologous stem cell transplant (ASCT) in immunoglobulin light chain (AL) amyloidosis remains controversial. Data on the prognostic impact of response to induction in a transplanted cohort are lacking. The aim of this study was to assess the impact of response to induction therapy on survival in patients undergoing ASCT for AL amyloidosis. Methods: We conducted a retrospective study of all newly diagnosed AL amyloidosis patients who received induction prior to ASCT between January 2007 and August 2017 at Mayo Clinic, Rochester, Minnesota. Patients receiving only corticosteroids prior to transplant were excluded as were those with an involved light chain of less than 5 mg/dL (not measurable for response). Results: 134 patients met inclusion criteria. The median age at diagnosis was 60 (range 36-74) and 85 (63%) were men. The most commonly used induction regimen was proteasome inhibitor-based (73.1%, n=98). The overall response rate to induction was 83% (complete response 17%, very good partial response 30% and partial response 36%). With a median follow up of 56.5 months, the median PFS and OS was 48.5 months and not reached, respectively. Response depth to induction therapy was associated with improved PFS and OS and was independent of the bone marrow plasma cell percentage. The median PFS was not reached for patients achieving ≥VGPR prior to ASCT and 33.8 months for patient achieving PR or less (P=0.001). The median OS was longer in patients with deeper responses (not reached for patients achieving ≥VGPR vs. 128 months for patients achieving PR or less (P=0.02). On multivariable analysis, independent predictors of OS were melphalan conditioning dose (RR= 0.38; P=0.018) and depth of response prior to transplant (RR 2.52; P=0.039). Conclusions: Hematologic response prior to transplant predicts post-transplant outcomes in patients with AL amyloidosis.

Univariable and multivariable analysis for overall survival.

VariableUnivariable
Multivariable
RR (95% CI)PRR (95% CI)P
Age ≥ 65 years3.5 (0.99 to 4.99)0.051.76 (0.76 to 4.05)0.185
More than 2 organs involved1.63 (0.27 to 3.9)0.268
BMPC≥10%0.45 (0.8 to 2.36)0.83
Mayo stage 2012 III/IV versus I/II1.65 (0.23 to 3.72)0.24
Conditioning melphalan dose 200 mg/m2 versus 140 mg/m20.38 (0.19 to 0.83)0.01640.38 (0.17 to 0.85)0.018
Hematologic responseCR/VGPR versus PR or less2.7
(1.2 to 6.37)
0.0272.52
(1.04 to 6.09)
0.039
Post-transplant treatment0.92 (0.5-1.65)0.7

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Poster Discussion Session

Session Title

Hematologic Malignancies—Plasma Cell Dyscrasia

Track

Hematologic Malignancies

Sub Track

Plasma Cell Disorders

Citation

J Clin Oncol 38: 2020 (suppl; abstr 8516)

DOI

10.1200/JCO.2020.38.15_suppl.8516

Abstract #

8516

Poster Bd #

416

Abstract Disclosures

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