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Published on: September 18, 2011
Cardiac and autologous stem cell transplantation hematopoietic in patients with AL amyloidosis
Marcelina Carretero1, Eugenia Villanueva2, Erika B Brulc3
1Área de Investigación en Medicina Interna, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires.
Insights
Orthotopic heart transplantation (OHT) followed by autologous stem cell transplantation (ASCT) offers a treatment pathway for AL amyloidosis. Patients achieved complete hematologic remission post-ASCT, indicating treatment effectiveness.
Area of Science:
- Hematology
- Transplantation Medicine
- Oncology
Background:
- AL amyloidosis can cause severe heart failure, necessitating advanced treatments.
- Orthotopic heart transplantation (OHT) can be a viable option for managing cardiac complications.
- Sequential OHT followed by autologous stem cell transplantation (ASCT) is an intensive therapeutic strategy.
Purpose of the Study:
- To evaluate serum free light chain (FLC) levels between OHT and ASCT.
- To assess hematological response one year post-ASCT in AL amyloidosis patients.
- To describe chemotherapy and immunosuppressive treatments used in this context.
Main Methods:
- A case series of AL amyloidosis patients who underwent OHT followed by ASCT.
- Analysis of FLC values pre- and post-ASCT.
- Description of patient demographics and treatment regimens.
Main Results:
- Six patients received OHT and ASCT, with a median age of 55.
- FLC levels showed a decrease or stability between transplants.
- All patients achieved complete hematologic remission one year after ASCT.
Conclusions:
- OHT is a treatment option for severe cardiac amyloidosis, enabling subsequent ASCT.
- Immunosuppressive therapy post-OHT may influence clonal plasma cells.
- This combined approach leads to significant hematological recovery in AL amyloidosis.
Objective:
To describe the evolution of serum free light chains (FLC) in the period between orthotopic heart transplantation (OHT) and autologous stem cell transplantation (ASCT), the hematological response one year after ASCT and chemotherapy and immunosuppressive treatment in patients with AL amyloidosis.
Method:
Case series of consecutive patients diagnosed with AL amyloidosis who received OHT followed by ASCT from the Institutional Registry of Amyloidosis of the Italian Hospital of Buenos Aires, between January 2010 and November 2021. FLC values between transplants and at year post ASCT. Quantitative variables were described with their median and interquartile range. Categorical variables as absolute and relative frequencies.
Results:
Of 106 patients with AL amyloidosis, 6 had an OHT followed by ASCT. The median age was 55 years. Most were men (n = 5). In the period between transplants, the involved CLL decreased in two patients and remained stable in three. All achieved complete hematologic remission 1 year after ASCT. A single patient presented relapse in the transplanted solid organ. Tacrolimus, mycophenolate mofetil, and corticosteroids were the immunosuppressive regimen used after OHT.
Conclusions:
OHT represents a treatment option in patients with severe heart failure due to amyloidosis, allowing later intensive treatment with induction chemotherapy and ASCT. Although studies are lacking, immunosuppressive therapy after OHT might have some effect on clonal plasma cells.
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