High-dose melphalan (HDM) and autologous blood stem cell transplantation (ABSCT) is an effective treatment for transplant-eligible patients with systemic light chain (AL) amyloidosis. Whereas most centers use granulocyte colony-stimulating factor (G-CSF) alone for mobilization of peripheral blood stem cells (PBSC), the application of mobilization chemotherapy might offer specific advantages. We retrospectively analyzed 110 patients with AL amyloidosis who underwent PBSC collection. Major eligibility criteria included age <70 years and cardiac insufficiency NYHA ≤III°. Prior to mobilization, 67 patients (61%) had been pre-treated with induction therapy, including 17 (15%) patients who had received melphalan. Chemotherapy mobilization was performed with either cyclophosphamide, adriamycin, dexamethasone (CAD)/G-CSF (n=78, 71%), ifosfamide/G-CSF (n=14, 13%) or other regimens (n=8, 7%). AL amyloidosis patients with predominant heart involvement and/or status post heart transplantation were mobilized with G-CSF only (n=10, 9%). PBSC collection was successful in 101 patients (92%) at first attempt. The median number of CD34(+) cells was 8.7 (range 2.1-45.5) x10(6) CD34(+)/kg collected in a median of one leukapheresis (LP) session. Compared to G-CSF mobilization only a chemo-mobilization with CAD/G-CSF or ifosfamide/G-CSF had a positive impact on the number of collected CD34(+) cell number/kg per LP (P<0.001, multivariate). Melphalan-containing previous therapy and higher age had a significant negative impact on quantity of collected CD34(+) cells. Median common toxicity criteria (CTC) grade of non-hematological toxicity was II (range 0-IV). Life-threatening CTC grade IV adverse events were observed in 3 patients with no fatalities. Cardiovascular events were observed in n=17 patients (22%) upon CAD/G-CSF mobilization (median CTC grade 3, range 1-4). Toxicity in patients undergoing ifosfamide/G-CSF mobilization was higher compared to G-CSF mobilization only. HDM and ABSCT were performed in 100 patients. Compared to >6.5 x10(6) transplanted CD34(+) cells/kg, an ABSCT with <3 x10(6) CD34(+) cells/kg was associated with a longer duration to leucocyte reconstitution >1/nl and a reduced platelet count <150/nl one year after ASCT. Our results show that CAD chemotherapy is very effective in PBSC mobilization and has a tolerable toxicity profile in AL amyloidosis patients. A further toxicity reduction by omission of adriamycin might be considered. Due to the advanced non-hematological toxicity ifosfamide administration cannot be recommended. However, G-CSF mobilization alone is also safe and effective. Considering the hematopoietic reconstitution and long-term stem cell function our results provide a rationale to collect and transplant as much as >6.5 x10(6) CD34+ cells/kg, if feasible with reasonable effort.
Pharmacology, Toxicology and Pharmaceutical Science
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2%
Mathematics
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Other
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9%
Unknown
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40%
Attention Score in Context
Attention Score in Context
This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 25 September 2017.
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#22,340,091
of 34,400,738 outputs
Outputs from Biology of Blood & Marrow Transplantation
#2,705
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#211,872
of 357,526 outputs
Outputs of similar age from Biology of Blood & Marrow Transplantation
#43
of 76 outputs
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