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  • Title: High-dose therapy with auto-SCT is feasible in high-risk cardiac amyloidosis.
    Author: Kongtim P, Qazilbash MH, Shah JJ, Hamdi A, Shah N, Bashir Q, Wang M, Champlin R, Manasanch EE, Weber D, Orlowski RZ, Parmar S.
    Journal: Bone Marrow Transplant; 2015 May; 50(5):668-72. PubMed ID: 25730192.
    Abstract:
    Cardiac involvement in light-chain amyloidosis (AL) predicts poor prognosis and is associated with higher TRM and morbidity during high-dose therapy and auto-SCT (HDT-ASCT). We studied the outcomes of 30 patients with cardiac amyloidosis undergoing HDT-ASCT at our center between January 1998 and March 2012. The median age of the patients was 53 years (range, 36-74) with a median follow-up of 35 months (range, 0.4-97 months). Twenty-seven patients (90%) had more than one organ involved besides the heart with 37% with cardiac stage ⩾3. Melphalan-based conditioning regimen (140-200 mg/m(2)) was used for HDT-ASCT. One-year TRM is 10%. Three-year OS and EFS from HDT-ASCT was 83% and 56.8%, respectively. Cumulative incidence of relapse at 3 years was 38.5%. Negative factors affecting survival included age >60 years, lack of novel induction therapy and BM plasmacytosis >10%. We conclude that HDT-ASCT is well tolerated in patients with high-risk cardiac amyloidosis and can lead to improved overall outcomes.
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