Prognostic restaging at the time of second-line therapy in patients with AL amyloidosis

Yi L. Hwa, Morie A. Gertz, Shaji K. Kumar, Martha Q. Lacy, Francis K. Buadi, David Dingli, Prashant Kapoor, Steve R. Zeldenrust, Nelson Leung, Susanne R. Hayman, Wilson I. Gonsalves, Taxiarchis V. Kourelis, Rahma Warsame, Ronald S. Go, Eli Muchtar, Miriam A. Hobbs, Amie L. Fonder, Stephen Russell, Robert A. Kyle, S. Vincent RajkumarAngela Dispenzieri

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


It is well known that staging of patients with AL amyloidosis at diagnosis predicts for survival, but there is a paucity of literature delineating the prognostic value of these systems at relapse. We evaluated the prognostic value of AL staging among 413 patients initiated with second-line therapy between 2000 and 2015. Both the Revised Mayo 2012 and the European revision of Mayo 2004 staging systems were used. The median time from initial treatment to second-line therapy was 11.7 months. The first-line therapy was autologous stem cell transplant (ASCT) in 179 (43%) patients and non-ASCT therapies in 234 patients. Median survival from the institution of second-line therapy was 61 months. Both the Mayo 2004 and 2012 staging systems were of prognostic benefit at second-line therapy with respective risk ratios of 2.78 (95% CI: 2.15, 3.58) and 3.03 (95% CI: 2.33, 3.93) for patients with > stage 2 disease. On multivariate analysis, the predictive value of staging at second-line therapy was independent of stage at diagnosis and prior ASCT as first-line therapy. This study indicates that the Mayo staging systems work well at second-line therapy. Consequently, it is suitable for the stratification of patients in trials for relapsed, refractory AL amyloidosis.

Original languageEnglish (US)
Pages (from-to)1268-1272
Number of pages5
Issue number5
StatePublished - May 1 2019

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research


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