TY - JOUR
T1 - Prognostic restaging after treatment initiation in patients with AL amyloidosis
AU - Abdallah, Nadine
AU - Dispenzieri, Angela
AU - Muchtar, Eli
AU - Buadi, Francis K.
AU - Kapoor, Prashant
AU - Lacy, Martha Q.
AU - Hwa, Yi L.
AU - Fonder, Amie
AU - Hobbs, Miriam A.
AU - Hayman, Suzanne R.
AU - Leung, Nelson
AU - Dingli, David
AU - Lust, John A.
AU - Go, Ronald S.
AU - Lin, Yi
AU - Gonsalves, Wilson I.
AU - Kourelis, Taxiarchis
AU - Warsame, Rahma
AU - Kyle, Robert A.
AU - Rajkumar, S. Vincent
AU - Gertz, Morie A.
AU - Kumar, Shaji K.
N1 - Publisher Copyright:
© 2021 by The American Society of Hematology.
PY - 2021/2/23
Y1 - 2021/2/23
N2 - The utility of systemic light chain (AL) amyloidosis staging systems has been validated for newly diagnosed patients, but their role in restaging after treatment has not been explored. We designed this study to evaluate whether the currently used systems are of prognostic value at 3 and 6 months of starting first-line treatment, and whether stage migration from diagnosis impacts survival. This is a retrospective study including Mayo Clinic patients with AL amyloidosis diagnosed between 1 January 2006 and 30 June 2019; 536 and 204 patients had restaging data for at least 1 system at 3 and 6 months, respectively. Using modified Mayo 2004 staging at 3 months, median overall survival (OSs) were 11.8, 10.8, 4.6, and 1.1 years for stage I, II, IIIa, and IIIb, respectively. Using Mayo 2012, median OSs were 11.8, 9.0, 5.2, and 0.8 years for stage I, II, III, and IV, respectively. Using modified Mayo 2004 staging at 6 months, median OSs were not reached (NR), NR, 5.4, and 0.9 years for stage I, II, IIIa, and IIIb, respectively. Using Mayo 2012, OSs were NR, NR, 4.6, and 0.9 years for stage I, II, III, and IV, respectively. Worsening stage at 3 or 6 months was associated with worse survival than retaining baseline stage. In conclusion, the current staging systems can be used for restaging at 3 and 6 months from treatment initiation. Migration to higher stage predicts poor prognosis.
AB - The utility of systemic light chain (AL) amyloidosis staging systems has been validated for newly diagnosed patients, but their role in restaging after treatment has not been explored. We designed this study to evaluate whether the currently used systems are of prognostic value at 3 and 6 months of starting first-line treatment, and whether stage migration from diagnosis impacts survival. This is a retrospective study including Mayo Clinic patients with AL amyloidosis diagnosed between 1 January 2006 and 30 June 2019; 536 and 204 patients had restaging data for at least 1 system at 3 and 6 months, respectively. Using modified Mayo 2004 staging at 3 months, median overall survival (OSs) were 11.8, 10.8, 4.6, and 1.1 years for stage I, II, IIIa, and IIIb, respectively. Using Mayo 2012, median OSs were 11.8, 9.0, 5.2, and 0.8 years for stage I, II, III, and IV, respectively. Using modified Mayo 2004 staging at 6 months, median OSs were not reached (NR), NR, 5.4, and 0.9 years for stage I, II, IIIa, and IIIb, respectively. Using Mayo 2012, OSs were NR, NR, 4.6, and 0.9 years for stage I, II, III, and IV, respectively. Worsening stage at 3 or 6 months was associated with worse survival than retaining baseline stage. In conclusion, the current staging systems can be used for restaging at 3 and 6 months from treatment initiation. Migration to higher stage predicts poor prognosis.
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U2 - 10.1182/bloodadvances.2020003782
DO - 10.1182/bloodadvances.2020003782
M3 - Article
C2 - 33595624
AN - SCOPUS:85102964156
SN - 2473-9529
VL - 5
SP - 1029
EP - 1036
JO - Blood Advances
JF - Blood Advances
IS - 4
ER -