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Improved Outcomes A...
Improved Outcomes After Autologous Hematopoietic Cell Transplantation for Light Chain Amyloidosis : A Center for International Blood and Marrow Transplant Research Study
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- D'Souza, Anita (författare)
- Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
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- Dispenzieri, Angela (författare)
- Mayo Clin, Rochester, MN USA.
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- Wirk, Baldeep (författare)
- Seattle Canc Care Alliance, Seattle, WA USA.
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- Zhang, Mei-Jie (författare)
- Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Milwaukee, WI 53226 USA.
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- Huang, Jiaxing (författare)
- Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
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- Gertz, Morie A. (författare)
- Mayo Clin, Rochester, MN USA.
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- Kyle, Robert A. (författare)
- Mayo Clin, Rochester, MN USA.
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- Kumar, Shaji (författare)
- Mayo Clin, Rochester, MN USA.
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- Comenzo, Raymond L. (författare)
- Tufts Med Ctr, Boston, MA USA.
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- Gale, Robert Peter (författare)
- Univ London Imperial Coll Sci Technol & Med, Hematol Res Ctr, London, England.
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- Lazarus, Hillard M. (författare)
- Univ Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA.
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- Savani, Bipin N. (författare)
- Vanderbilt Univ, Med Ctr, Nashville, TN USA.
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- Cornell, Robert F. (författare)
- Vanderbilt Univ, Med Ctr, Nashville, TN USA.
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- Weiss, Brendan M. (författare)
- Univ Penn, Med Ctr, Abramson Canc Ctr, Philadelphia, PA 19104 USA.
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- Vogl, Dan T. (författare)
- Univ Penn, Med Ctr, Abramson Canc Ctr, Philadelphia, PA 19104 USA.
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- Freytes, Cesar O. (författare)
- South Texas Vet Hlth Care Syst, San Antonio, TX USA.;Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA.
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- Scott, Emma C. (författare)
- Oregon Hlth & Sci Univ, Knight Canc Inst, Ctr Hematol Malignancies, Portland, OR 97201 USA.
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- Landau, Heather J. (författare)
- Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA.
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- Moreb, Jan S. (författare)
- Shands HealthCare, Gainesville, FL USA.;Univ Florida, Gainesville, FL USA.
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- Costa, Luciano J. (författare)
- Univ Alabama Birmingham, Birmingham, AL USA.
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- Ramanathan, Muthalagu (författare)
- Univ Massachusetts, Mem Med Ctr, Worcester, MA 01605 USA.
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- Callander, Natalie S. (författare)
- Univ Wisconsin, Carbone Canc Ctr, Madison, WI USA.
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- Kamble, Rammurti T. (författare)
- Baylor Coll Med, Ctr Cell & Gene Therapy, Houston, TX 77030 USA.
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- Olsson, Richard F. (författare)
- Karolinska Institutet,Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Karolinska Inst, Stockholm, Sweden.
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- Ganguly, Siddhartha (författare)
- Univ Kansas, Med Ctr, Kansas City, KS 66103 USA.
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- Nishihori, Taiga (författare)
- Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Tampa, FL 33612 USA.
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- Kindwall-Keller, Tamila L. (författare)
- Univ Virginia Hlth Syst, Charlottesville, VA USA.
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- Wood, William A. (författare)
- Univ N Carolina, Chapel Hill, NC USA.
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- Mark, Tomer M. (författare)
- Weill Cornell Med Coll, New York, NY USA.
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- Hari, Parameswaran (författare)
- Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
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Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA Mayo Clin, Rochester, MN USA. (creator_code:org_t)
- 2015
- 2015
- Engelska.
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Ingår i: Journal of Clinical Oncology. - 0732-183X .- 1527-7755. ; 33:32, s. 3741-
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
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- Purpose Autologous hematopoietic cell transplantation, or autotransplantation, is effective in light-chain amyloidosis (AL), but it is associated with a high risk of early mortality (EM). In a multicenter randomized comparison against oral chemotherapy, autotransplantation was associated with 24% EM. We analyzed trends in outcomes after autologous hematopoietic cell transplantation for AL in North America. Patients and Methods Between 1995 and 2012, 1,536 patients with AL who underwent autotransplantation at 134 centers were identified in the Center for International Blood and Marrow Transplant Research database. EM and overall survival (OS) were analyzed in three time cohorts: 1995 to 2000 (n = 140), 2001 to 2006 (n = 596), and 2007 to 2012 (n = 800). Hematologic and renal responses and factors associated with EM, relapse and/or progression, progression-free survival and OS were analyzed in more recent subgroups from 2001 to 2006 (n = 197) and from 2007 to 2012 (n = 157). Results Mortality at 30 and 100 days progressively declined over successive time periods from 11% and 20%, respectively, in 1995 to 2000 to 5% and 11%, respectively, in 2001 to 2006, and to 3% and 5%, respectively, in 2007 to 2012. Correspondingly, 5-year OS improved from 55% in 1995 to 2000 to 61% in 2001 to 2006 and to 77% in 2007 to 2012. Hematologic response to transplantation improved in the latest cohort. Renal response rate was 32%. Centers performing more than four AL transplantations per year had superior survival outcomes. In the multivariable analysis, cardiac AL was associated with high EM and inferior progression-free survival and OS. Autotransplantation in 2007 to 2012 and use of higher dosages of melphalan were associated with a lowered relapse risk. A Karnofsky score less than 80 and creatinine levels 2 mg/m(2) or greater were associated with worsened OS. Conclusion Post-transplantation survival in AL has improved, with a dramatic reduction in early post-transplantation mortality and excellent 5-year survival. The risk-benefit ratio for autotransplantation has changed, and randomized comparison with nontransplantation approaches is again warranted.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
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D'Souza, Anita
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Dispenzieri, Ang ...
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Wirk, Baldeep
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Zhang, Mei-Jie
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Huang, Jiaxing
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Gertz, Morie A.
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Kyle, Robert A.
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Kumar, Shaji
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Comenzo, Raymond ...
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Gale, Robert Pet ...
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Lazarus, Hillard ...
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Savani, Bipin N.
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Cornell, Robert ...
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Weiss, Brendan M ...
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Vogl, Dan T.
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Freytes, Cesar O ...
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Scott, Emma C.
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Landau, Heather ...
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Moreb, Jan S.
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Costa, Luciano J ...
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Ramanathan, Muth ...
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Callander, Natal ...
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Kamble, Rammurti ...
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Olsson, Richard ...
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Ganguly, Siddhar ...
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Nishihori, Taiga
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Kindwall-Keller, ...
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Wood, William A.
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Mark, Tomer M.
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Hari, Parameswar ...
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Uppsala universitet
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Karolinska Institutet