Blood Res.  2021 Dec;56(4):266-278. 10.5045/br.2021.2021121.

Outcomes of bortezomib combination chemotherapies in autologous stem cell transplantation-ineligible patients with AL amyloidosis

• Hur JY
• Yoon SE
• Kim D
• Choi Jo
• Min JH
• Kim BJ
• Kim JS
• Lee JE
• Choi JY
• Jeon ES
• Kim SJ
• Kim K

• KMID: 2524086
• DOI: http://doi.org/10.5045/br.2021.2021121

Abstract

Background
Treatment protocols for light chain (AL) amyloidosis have been derived from myeloma treatment. Bortezomib is a key drug used for the treatment of myeloma and AL amyloidosis. We retrospectively investigated the efficacy and toxicity of bortezomib-based chemotherapy in patients with newly diagnosed AL amyloidosis.
Methods
We reviewed the outcomes of newly diagnosed autologous stem cell transplantation (auto-SCT)-ineligible AL amyloidosis patients who received bortezomib-based chemotherapy at a referral center between 2011 and 2017.
Results
Of 63 patients who received bortezomib-based chemotherapy, 32 were male, and the median age was 66 years (range, 42‒82 yr). The hematologic overall response rate (ORR) was 65.1%, and the chemotherapy regimen with the best hematologic response was VMP (75.7%, 28/37). Sixty patients had significant organ (heart or kidney) involvement; 28.3% of patients (N=17) had major organ responses after chemotherapy. With a median follow-up of 34 months, there was no significant difference in progression-free survival (P =0.49) or overall survival (P =0.67) according to regimen. Most hematologic and non-hematologic problems were manageable.
Conclusion
Various chemotherapy combinations based on bortezomib are currently employed in the clinical setting, but no difference was found in terms of efficacy or toxicity.

Keyword

Bortezomib; Light-chain amyloidosis; Transplant ineligible

Figure

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  Fig. 1 Progression-free survival (PFS) of all patients (A), PFS according to MAYO 2012 stage (B), PFS of patients with organ involvement (C), PFS of patients who achieved an organ response (D), PFS of patients who achieved a hematologic response (E), comparison of PFS according to chemotherapy (F).

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  Fig. 2 Overall survival (OS) of all patients (A), OS according to MAYO 2012 stage (B), OS of patients with organ involvement (C), OS of patients who achieved an organ response (D), OS of patients who achieved a hematologic response (E), comparison of OS according to chemotherapy (F).

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