TY - JOUR
T1 - Bone marrow plasma cells 20% or greater discriminate presentation, response, and survival in AL amyloidosis
AU - Muchtar, Eli
AU - Gertz, Morie A.
AU - Kourelis, Taxiarchis V.
AU - Sidana, Surbhi
AU - Go, Ronald S.
AU - Lacy, Martha Q.
AU - Buadi, Francis K.
AU - Dingli, David
AU - Hayman, Suzanne R.
AU - Kapoor, Prashant
AU - Leung, Nelson
AU - Fonder, Amie
AU - Hobbs, Miriam
AU - Lisa Hwa, Yi
AU - Gonsalves, Wilson
AU - Warsame, Rahma
AU - Russell, Stephen
AU - Lust, John A.
AU - Lin, Yi
AU - Zeldenrust, Steven
AU - Rajkumar, S. Vincent
AU - Kyle, Robert A.
AU - Kumar, Shaji K.
AU - Dispenzieri, Angela
N1 - Publisher Copyright:
© 2019, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2020/4
Y1 - 2020/4
N2 - We explored the association between bone marrow plasma cells (BMPCs) and disease presentation and outcome among 1574 AL patients. Three BMPC groups were formulated: <5% (n = 231, 15% of study population), 5–19% (n = 1045, 66%), and ≥20% (n = 298, 19%). Heart and renal involvement were more and less prevalent, respectively, with increasing BMPCs. Patients with ≥20% BMPCs had higher likelihood for classic myeloma phenotype with less skewed lambda restriction, a higher rate of intact immunoglobulin secretion, a lower hemoglobin and higher rates of hypercalcemia and bone lytic lesions. High-risk cytogenetic abnormalities were more common in ≥20% BMPCs. Complete hematological response was less frequent with rising BMPCs. The median survival was inversely associated with the BMPC groups (81, 33, 12 months for <5%, 5–19%, and ≥20% BMPCs, respectively; P < 0.001). Survival discrimination was maintained at 1-year landmark and in those who achieved a complete response. Multivariate analysis accounting for known prognostic markers yielded an independent prognostic role for ≥20% BMPCs, but not for the other BMPC groups. AL patients with 20% or greater BMPCs have poorer outcome independent of their cardiac risk category and stem cell transplant eligibility. Distinct interventions in these patients should be explored to improve outcome.
AB - We explored the association between bone marrow plasma cells (BMPCs) and disease presentation and outcome among 1574 AL patients. Three BMPC groups were formulated: <5% (n = 231, 15% of study population), 5–19% (n = 1045, 66%), and ≥20% (n = 298, 19%). Heart and renal involvement were more and less prevalent, respectively, with increasing BMPCs. Patients with ≥20% BMPCs had higher likelihood for classic myeloma phenotype with less skewed lambda restriction, a higher rate of intact immunoglobulin secretion, a lower hemoglobin and higher rates of hypercalcemia and bone lytic lesions. High-risk cytogenetic abnormalities were more common in ≥20% BMPCs. Complete hematological response was less frequent with rising BMPCs. The median survival was inversely associated with the BMPC groups (81, 33, 12 months for <5%, 5–19%, and ≥20% BMPCs, respectively; P < 0.001). Survival discrimination was maintained at 1-year landmark and in those who achieved a complete response. Multivariate analysis accounting for known prognostic markers yielded an independent prognostic role for ≥20% BMPCs, but not for the other BMPC groups. AL patients with 20% or greater BMPCs have poorer outcome independent of their cardiac risk category and stem cell transplant eligibility. Distinct interventions in these patients should be explored to improve outcome.
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U2 - 10.1038/s41375-019-0655-x
DO - 10.1038/s41375-019-0655-x
M3 - Article
C2 - 31758090
AN - SCOPUS:85075318407
SN - 0887-6924
VL - 34
SP - 1135
EP - 1143
JO - Leukemia
JF - Leukemia
IS - 4
ER -