ABSTRACT
INTRODUCTION/BACKGROUND: High-dose melphalan (HDM) followed by autologous stem cell transplant (ASCT) for light chain amyloidosis (AL) was performed in 31 patients at Oregon Health and Science University between 2005 and 2012. Fifteen patients had cardiac involvement. PATIENTS AND METHODS: Patients received melphalan 200 mg/m(2) or dose-adjusted HDM (100-140 mg/m(2)) depending on high risk features. Thirteen patients proceeded directly to ASCT after diagnosis, 12 patients received a bortezomib-containing regimen, and 6 received a variety of other induction regimens. RESULTS: The day 100 treatment-related mortality was 9.6%. Overall hematologic (ORR) and organ response rates (OR) in the whole cohort after ASCT were 77% and 58%. ORR and OR in the bortezomib pretreated group were 92% and 75% vs. 69% and 54% in the group that received no pretreatment. The median time to maximum hematologic response after ASCT was reduced in the group that received bortezomib induction (3 vs. 14 months). Overall cardiac response rate was 60%; 100% in patients pretreated with bortezomib and 43% in those without induction treatment. With a median follow-up of 2.9 years, the 3-year progression-free and overall survival rates in the entire cohort were 66% and 73% and in those with cardiac involvement, 73% and 80%. CONCLUSION: We observed that bortezomib-based induction is well tolerated in patients with and without cardiac involvement and suggest that this approach be studied in prospective multi-institutional trials.
Subject(s)
Amyloidosis/drug therapy , Boronic Acids/therapeutic use , Hematopoietic Stem Cell Transplantation , Melphalan/therapeutic use , Myeloablative Agonists/therapeutic use , Proteasome Inhibitors/therapeutic use , Pyrazines/therapeutic use , Transplantation Conditioning , Adult , Aged , Amyloidogenic Proteins/analysis , Amyloidosis/complications , Amyloidosis/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Boronic Acids/administration & dosage , Bortezomib , Cardiomyopathies/etiology , Cyclophosphamide/administration & dosage , Dexamethasone/administration & dosage , Disease-Free Survival , Drug Administration Schedule , Female , Humans , Immunoglobulin Light Chains/analysis , Kaplan-Meier Estimate , Kidney Diseases/etiology , Lenalidomide , Male , Melphalan/administration & dosage , Middle Aged , Myeloablative Agonists/administration & dosage , Proteasome Inhibitors/administration & dosage , Pyrazines/administration & dosage , Remission Induction , Retrospective Studies , Thalidomide/administration & dosage , Thalidomide/analogs & derivatives , Transplantation, Autologous , Treatment OutcomeABSTRACT
High-dose therapy with autologous stem cell transplant (autoSCT) is standard therapy for relapsed/refractory Hodgkin lymphoma, although the optimal conditioning regimen remains uncertain. We conducted a retrospective analysis of 100 consecutive patients with relapsed/refractory Hodgkin lymphoma who underwent autoSCT between 1998 and 2009. There were 60 patients who received busulfan, melphalan and thiotepa (BuMelTt) conditioning and 40 who received other common regimens. There were no significant differences in patient characteristics between the two groups. With a median follow-up of 4.3 years, the 5-year overall survival (OS) was superior for patients who received BuMelTt versus other conditioning (73% vs. 44%, p = 0.05). BuMelTt was also associated with an improved 5-year progression-free survival (66% vs. 37%, p = 0.03). There were no differences in length of hospitalization, febrile neutropenia, hepatic veno-occlusive disease or 100-day non-relapse mortality (NRM). There were more cases of severe mucositis but fewer episodes of bacteremia with BuMelTt. Our results suggest that BuMelTt may be a superior conditioning regimen for autoSCT in Hodgkin lymphoma.
