The impact of melphalan conditioning and CD34(+) cell dose and schedule on post-transplant outcomes in AL amyloidosis Journal Article
| Authors: | Muchtar, E.; Sanchorawala, V.; Hassan, H.; Hegenbart, U.; Schönland, S.; Lee, H. C.; Qazilbash, M.; Kin, A.; Zonder, J.; Jacob, E.; Buadi, F.; Dispenzieri, A.; Dingli, D.; Arai, S.; Chin, M.; Chakraborty, R.; Lentzsch, S.; Magen, H.; Shkury, E.; Sarubbi, C.; Landau, H.; Gertz, M. |
| Article Title: | The impact of melphalan conditioning and CD34(+) cell dose and schedule on post-transplant outcomes in AL amyloidosis |
| Abstract: | The optimal conditioning schedule and CD34+ cell dose for autologous stem cell transplantation (ASCT) for AL amyloidosis is unknown. Patients (n = 1704) who underwent ASCT for AL amyloidosis between 2003 and 2020 in 9 centers were included. Data on melphalan conditioning dose, number of conditioning days, whether a rest day between conditioning and stem cell infusion was given or not, and infused CD34+ cell dose were collected. Full-dose melphalan (≥ 180 mg/m2) was administered in 63.7% of the patients, and 80.4% had melphalan split into 2-day conditioning. A rest day (day −1) between the conditioning regimen and stem cell infusion was provided in 52.5% of patients. The median infused CD34+ cell count was 4.7 × 106/kg. An infused CD34+ cell count ≥ 4.5 × 106/kg was associated with a shorter time to neutrophil and platelet engraftment. In a nominal regression analysis, full-dose melphalan, 1-day melphalan conditioning, and omitting a rest day between conditioning and stem cell infusion were independent predictors of post-ASCT higher deep hematological response. The median follow-up was 8.6 years, and 38% of patients died. Independent predictors of superior overall survival in multivariate Cox regression analysis included full-dose melphalan, having no rest day, and infused CD34+ cells ≥ 4.5 × 106/kg. Independent predictors of higher day-100 transplant-related mortality (TRM) in nominal logistic regression analysis included poorer performance status, NT-proBNP/BNP ≥ 1800/400 pg/mL, serum albumin < 2.5 g/dL, CD34+ cells < 4.5 × 106/kg, and not having a rest day. In conclusion, 1 day of melphalan conditioning and administration of CD34+ cells ≥ 4.5 × 106/kg are recommended for ASCT in AL amyloidosis. © 2025 Wiley Periodicals LLC. |
| Keywords: | adult; treatment outcome; aged; middle aged; retrospective studies; overall survival; clinical trial; mortality; follow up; cd34 antigen; cyclophosphamide; melphalan; autologous stem cell transplantation; hematopoietic stem cell transplantation; retrospective study; blood; albumin; engraftment; multicenter study; transplantation conditioning; antigens, cd34; plerixafor; transplantation, autologous; therapy; autotransplantation; procedures; bmt; amino terminal pro brain natriuretic peptide; al amyloidosis; estimated glomerular filtration rate; humans; human; male; female; article; absolute neutrophil count; ecog performance status; immunoglobulin light-chain amyloidosis; marrow/stem cell transplantation-clinical results in myeloma; neoplasia-myeloma and other plasma cell dyscrasias |
| Journal Title: | American Journal of Hematology |
| Volume: | 100 |
| Issue: | 7 |
| ISSN: | 0361-8609 |
| Publisher: | John Wiley & Sons, Inc. |
| Date Published: | 2025-07-01 |
| Start Page: | 1141 |
| End Page: | 1151 |
| Language: | English |
| DOI: | 10.1002/ajh.27685 |
| PUBMED: | 40214172 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work