AL amyloidosis treated with induction chemotherapy with VAD followed by high dose melphalan and autologous stem cell transplantation

[No Value] van Gameren, BPC Hazenberg, PL Jager, JW Smit, E Vellenga

OnderzoeksoutputAcademicpeer review

45 Citaten (Scopus)

Samenvatting

High dose melphalan (HDM) followed by reinfusion of autologous blood stem cells (ASCT) has been applied in AL amyloidosis. Vincristine, doxorubicin, and dexamethasone (VAD) rapidly decrease light chain production in multiple myeloma.

In a Phase III study of VA D followed by HDM and ASCT in AL amyloidosis, toxicity, feasibility, and response to this regimen were evaluated Over a 5-year period 38 patients with AL amyloidosis were seen of which 12 out of 18 eligible patients participated in the study.

VAD induced a distinct clonal response in 50% (6/12) of the patients, but without clinical improvement. In I I patients HDM and ASCT was applied Six months after ASCT 78% (7/9) of the surviving patients showed partial clonal response and none responded completely. Clinical condition evidently improved in 67% (6/9) of survivors, whereby clonal response, clinical response, performance score, and SAP scintigraphs were concordant. Therefore a complete clonal response is not a prerequisite for clinical improvement.

With median follow-up after ASCT of 25 months, 75% of the study group patients were alive. Mortality was strongly depending on the number of organs involved Patients treated with HDM and ASCT had better survival than those not eligible (P <0.0005).

Originele taal-2English
Pagina's (van-tot)165-174
Aantal pagina's10
TijdschriftAmyloid: Journal of protein folding disorders
Volume9
Nummer van het tijdschrift3
StatusPublished - sep-2002

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