Short and long-term outcome of treatment with high-dose melphalan and stem cell transplantation for multiple myeloma-associated AL amyloidosis

Ann Hematol. 2010 Jun;89(6):579-84. doi: 10.1007/s00277-009-0874-8. Epub 2009 Dec 10.

Abstract

High-dose melphalan chemotherapy and autologous peripheral blood stem cell transplantation (HDM/SCT) has been shown to result in a durable hematologic response and prolonged overall survival in systemic amyloid light-chain (AL) amyloidosis as well as multiple myeloma. However, little is known about the myeloma associated with AL amyloidosis (MM/AL). In this retrospective study, we evaluated 87 patients with MM/AL from 1994 to 2007. Sixteen of these patients underwent HDM/SCT at Boston University Medical Center. Three patients (19%) died from treatment-related mortality. The overall median survival for all 87 patients was 22 months by Kaplan-Meier estimates. However, this was improved to 54.5 months for those who received HDM/SCT compared to 21 months for those who did not receive HDM/SCT. A hematologic complete response was achieved by 25% (4/16) of patients at 6 months after HDM/SCT. Hematologic relapses occurred in 60% of patients at a median of 1 year after HDM/SCT. In conclusion, HDM/SCT can prolong overall survival in patients with MM/AL who are eligible to receive it.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amyloid / metabolism
  • Amyloidosis / complications
  • Amyloidosis / drug therapy*
  • Amyloidosis / metabolism
  • Amyloidosis / mortality
  • Antineoplastic Agents, Alkylating / administration & dosage
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Male
  • Melphalan / administration & dosage*
  • Middle Aged
  • Multiple Myeloma / complications
  • Multiple Myeloma / drug therapy*
  • Multiple Myeloma / mortality
  • Protein Subunits / metabolism
  • Retrospective Studies
  • Stem Cell Transplantation*
  • Survival Analysis
  • Time Factors
  • Treatment Outcome

Substances

  • Amyloid
  • Antineoplastic Agents, Alkylating
  • Protein Subunits
  • Melphalan