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Biol Blood Marrow Transplant. 2015 Aug;21(8):1445-51. doi: 10.1016/j.bbmt.2015.04.001. Epub 2015 Apr 6.

Induction Therapy with Bortezomib Followed by Bortezomib-High Dose Melphalan and Stem Cell Transplantation for Light Chain Amyloidosis: Results of a Prospective Clinical Trial.

Author information

1
Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts. Electronic address: vaishali.sanchorawala@bmc.org.
2
Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.
3
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.

Abstract

The depth of hematologic response has been shown to correlate with survival and organ responses for patients with light chain (AL) amyloidosis. We conducted a prospective trial of 2 cycles of induction with bortezomib and dexamethasone on a twice a week schedule followed by conditioning with bortezomib and high-dose melphalan (HDM) and autologous stem cell transplantation (SCT). The objectives were hematologic responses, tolerability, and survival. Thirty-five patients were enrolled from 2010 to 2013. Of these, 30 proceeded with SCT, whereas 5 did not because of clinical deterioration during induction (n = 3) or complications after stem cell collection (n = 2). Two patients developed features of an autologous graft-versus-host disease-like syndrome post-SCT, which responded to steroids; no other unusual complications were seen. Treatment-related mortality occurred in 8.5% (3/35). Hematologic responses were achieved by 100% of the 27 assessable patients (63% complete response, 37% very good partial response [VGPR]) who completed the planned treatment. By intention-to-treat, hematologic responses occurred in 77% of patients (49% complete response, 29% VGPR). With a median follow-up of 36 months, the median overall survival and progression-free survival were not reached. In conclusion, incorporating bortezomib into induction and conditioning yielded a high rate of hematologic responses after HDM/SCT in patients with AL amyloidosis.

KEYWORDS:

AL amyloidosis; Bortezomib; Induction; Melphalan; Stem cell transplantation

PMID:
25858810
DOI:
10.1016/j.bbmt.2015.04.001
[Indexed for MEDLINE]
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