Lenalidomide and dexamethasone in relapsed/refractory immunoglobulin light chain (AL) amyloidosis: results from a large cohort of patients with long follow-up.
Adult
Aged
Antineoplastic Agents, Hormonal
/ administration & dosage
Biomarkers
/ metabolism
Cohort Studies
Dexamethasone
/ administration & dosage
Drug Therapy, Combination
/ methods
Female
Follow-Up Studies
Humans
Immunoglobulin Light Chains
/ immunology
Immunoglobulin Light-chain Amyloidosis
/ diagnosis
Immunologic Factors
/ administration & dosage
Lenalidomide
/ administration & dosage
Male
Middle Aged
Natriuretic Peptide, Brain
/ metabolism
Peptide Fragments
/ metabolism
Prognosis
Progression-Free Survival
Recurrence
Retrospective Studies
AL amyloidosis
biomarkers
gain 1q21
lenalidomide
prognosis
Journal
British journal of haematology
ISSN: 1365-2141
Titre abrégé: Br J Haematol
Pays: England
ID NLM: 0372544
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
14
06
2021
received:
24
03
2021
accepted:
15
06
2021
pubmed:
4
8
2021
medline:
17
12
2021
entrez:
3
8
2021
Statut:
ppublish
Résumé
Lenalidomide and dexamethasone (RD) is a standard treatment in relapsed/refractory immunoglobulin light chain (AL) amyloidosis (RRAL). We retrospectively investigated toxicity, efficacy and prognostic markers in 260 patients with RRAL. Patients received a median of two prior treatment lines (68% had been bortezomib-refractory; 33% had received high-dose melphalan). The median treatment duration was four cycles. The 3-month haematological response rate was 31% [very good haematological response (VGHR) in 18%]. The median follow-up was 56·5 months and the median overall survival (OS) and haematological event-free survival (haemEFS) were 32 and 9 months. The 2-year dialysis rate was 15%. VGHR resulted in better OS (62 vs. 26 months, P < 0·001). Cardiac progression predicted worse survival (22 vs. 40 months, P = 0·027), although N-terminal prohormone of brain natriuretic peptide (NT-proBNP) increase was frequently observed. Multivariable analysis identified these prognostic factors: NT-proBNP for OS [hazard ratio (HR) 1·71; P < 0·001]; gain 1q21 for haemEFS (HR 1·68, P = 0·014), with a trend for OS (HR 1·47, P = 0·084); difference between involved and uninvolved free light chains (dFLC) and light chain isotype for OS (HR 2·22, P < 0·001; HR 1·62, P = 0·016) and haemEFS (HR 1·88, P < 0·001; HR 1·59, P = 0·008). Estimated glomerular filtration rate (HR 0·71, P = 0·004) and 24-h proteinuria (HR 1·10, P = 0·004) were prognostic for renal survival. In conclusion, clonal and organ biomarkers at baseline identify patients with favourable outcome, while VGHR and cardiac progression define prognosis during RD treatment.
Substances chimiques
Antineoplastic Agents, Hormonal
0
Biomarkers
0
Immunoglobulin Light Chains
0
Immunologic Factors
0
Peptide Fragments
0
pro-brain natriuretic peptide (1-76)
0
Natriuretic Peptide, Brain
114471-18-0
Dexamethasone
7S5I7G3JQL
Lenalidomide
F0P408N6V4
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
230-243Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.
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