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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

Rosengren, S. ; Mellqvist, U. H. ; Nahi, H. ; Forsberg, K. ; Lenhoff, S. LU ; Strömberg, O. ; Ahlberg, L. ; Linder, O. and Carlson, K. (2016) In Bone Marrow Transplantation 51(12). p.1569-1572
Abstract

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... (More)

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.

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publishing date
type
Contribution to journal
publication status
published
subject
in
Bone Marrow Transplantation
volume
51
issue
12
pages
4 pages
publisher
Nature Publishing Group
external identifiers
  • pmid:27694943
  • scopus:84989853560
ISSN
0268-3369
DOI
10.1038/bmt.2016.249
language
English
LU publication?
no
id
acb5f792-e674-4315-9cc6-78fbec130c7a
date added to LUP
2016-12-28 14:24:49
date last changed
2023-01-06 18:54:04
@article{acb5f792-e674-4315-9cc6-78fbec130c7a,
  abstract     = {{<p>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.</p>}},
  author       = {{Rosengren, S. and Mellqvist, U. H. and Nahi, H. and Forsberg, K. and Lenhoff, S. and Strömberg, O. and Ahlberg, L. and Linder, O. and Carlson, K.}},
  issn         = {{0268-3369}},
  language     = {{eng}},
  month        = {{12}},
  number       = {{12}},
  pages        = {{1569--1572}},
  publisher    = {{Nature Publishing Group}},
  series       = {{Bone Marrow Transplantation}},
  title        = {{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}},
  url          = {{http://dx.doi.org/10.1038/bmt.2016.249}},
  doi          = {{10.1038/bmt.2016.249}},
  volume       = {{51}},
  year         = {{2016}},
}