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Autografting

Patients with immunoglobulin light chain amyloidosis undergoing autologous stem cell transplantation have superior outcomes compared with patients with multiple myeloma: a retrospective review from a tertiary referral center.

Abstract

The underlying plasma cell clones in multiple myeloma (MM) and Ig light-chain amyloidosis (AL) appear to be different not only in terms of ‘tumor burden’ but also in terms of their underlying biology. High-dose chemotherapy with auto-SCT is one method of reducing the clone size and thereby improving OS. Post-auto-SCT outcomes between the two diseases have never been formally compared. Among all patients with a diagnosis of AL or MM who received auto-SCT as primary therapy at the Mayo Clinic, Rochester, there were higher CR rates (40% versus 29%, P<0.0001) in the AL group. The respective median OS for the AL and MM patients was 113 and 59.5 months, respectively, P<0.0001. Among patients achieving CR, MM patients had a fivefold risk of death as compared with AL patients. Although auto-SCT cannot be offered to all patients with either AL or MM, it appears that for those well enough to be chosen for the procedure, greater benefit is derived among the AL patients. This difference in survival is most notable among those patients who achieve CR, suggesting very different plasma cell biology between the two diseases.

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Acknowledgements

This work was supported in part by the JABBS foundation, the Predolin Foundation and the Robert A Kyle Hematologic Malignancies Fund. This was also supported in part by a generous gift from Mr Howard Weitzman’s 2011 Gala in Support of Amyloid Research and Awareness.

Author Contributions

AD: Designed study, collected and reviewed data, performed data analyses, cared for patients, wrote and reviewed manuscript. KS: Collected and reviewed data, performed data analyses, assisted in the writing of manuscript. MQL, SKK, FKB, SRH, MRL, DAG, DJI, INM, SMA, PBJ, LFP, MMP, WJH: Cared for patients and provided critical review of the manuscript. DD: Cared for patients and reviewed manuscript. MAAG: Collected and reviewed data, cared for patients and reviewed manuscript.

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Correspondence to A Dispenzieri.

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Competing interests

AD: Research dollars from Celgene, Janssen and Millennium. MQL: Clinical trial dollars from Celgene. SKK: Research dollars from Celgene and Millennium. M.A.G.: Honoraria from Binding Site. The remaining authors declared no conflict of interest.

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Dispenzieri, A., Seenithamby, K., Lacy, M. et al. Patients with immunoglobulin light chain amyloidosis undergoing autologous stem cell transplantation have superior outcomes compared with patients with multiple myeloma: a retrospective review from a tertiary referral center.. Bone Marrow Transplant 48, 1302–1307 (2013). https://doi.org/10.1038/bmt.2013.53

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