PMID- 28314084
OWN - NLM
STAT- MEDLINE
DCOM- 20170724
LR  - 20190221
IS  - 1096-8652 (Electronic)
IS  - 0361-8609 (Linking)
VI  - 92
IP  - 6
DP  - 2017 Jun
TI  - Treatment patterns and outcome following initial relapse or refractory disease in 
      patients with systemic light chain amyloidosis.
PG  - 549-554
LID - 10.1002/ajh.24723 [doi]
AB  - We analyzed the outcomes following initial relapse or refractory disease in 
      systemic light chain amyloidosis (AL) and the impact of type of therapy 
      employed.A total of 1327 patients with AL seen at Mayo Clinic within 90 days of 
      diagnosis, between 2006 and 2015, were reviewed. The study included 366 patients 
      experiencing a documented hematological or organ relapse or refractory disease 
      requiring start of second line therapy. Overall survival (OS) and time to next 
      treatment (TTNT) were calculated from start of second line treatment.The median 
      time to require second line treatment was 16.2 months (1-93) from the start of 
      first line therapy. At relapse, patients received proteasome inhibitors (PI; 
      45.1%), immunomodulators (IMiD; 22.7%), alkylators (9%), PI and IMiD combination 
      (4.1%), autologous transplant (3.8%), steroids and other therapies (4.9%). Among 
      these, 124 (33.9%) required change or reinstitution of therapy. The median time 
      to require third line treatment was 31 months (95% CI; 24, 40.5) and the median 
      overall survival (OS) was 38.8 months (95% CI; 29.6, 52.6) from the start of 
      second line treatment. Retreatment with same therapy at relapse significantly 
      reduced TTNT (22 m vs 32.3 m; P = .01) as compared to different therapy; but did 
      not have any impact OS (30.8 m vs 51.1 m; P = .5). In conclusion, this study 
      provides important information about outcomes of patients with AL who require 
      second line treatment for relapsed/refractory disease . Treatment with a 
      different therapy at relapse improves time to next therapy but does not impact 
      OS.
CI  - (c) 2017 Wiley Periodicals, Inc.
FAU - Tandon, Nidhi
AU  - Tandon N
AUID- ORCID: 0000-0003-4008-9081
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Sidana, Surbhi
AU  - Sidana S
AUID- ORCID: 0000-0003-3288-7614
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Gertz, Morie A
AU  - Gertz MA
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Dispenzieri, Angela
AU  - Dispenzieri A
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Lacy, Martha Q
AU  - Lacy MQ
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Buadi, Francis K
AU  - Buadi FK
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Dingli, David
AU  - Dingli D
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Fonder, Amie L
AU  - Fonder AL
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Hobbs, Miriam A
AU  - Hobbs MA
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Hayman, Suzanne R
AU  - Hayman SR
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Gonsalves, Wilson I
AU  - Gonsalves WI
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Hwa, Yi Lisa
AU  - Hwa YL
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Kapoor, Prashant
AU  - Kapoor P
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Kyle, Robert A
AU  - Kyle RA
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Leung, Nelson
AU  - Leung N
AUID- ORCID: 0000-0002-5651-1411
AD  - Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Go, Ronald S
AU  - Go RS
AUID- ORCID: 0000-0002-8284-3495
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Lust, John A
AU  - Lust JA
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Russell, Stephen J
AU  - Russell SJ
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Zeldenrust, Steven R
AU  - Zeldenrust SR
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Rajkumar, S Vincent
AU  - Rajkumar SV
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Kumar, Shaji K
AU  - Kumar SK
AD  - Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
LA  - eng
PT  - Journal Article
DEP - 20170426
PL  - United States
TA  - Am J Hematol
JT  - American journal of hematology
JID - 7610369
RN  - 0 (Immunoglobulin Light Chains)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Amyloidosis/diagnosis/*metabolism/mortality/*therapy
MH  - Antineoplastic Combined Chemotherapy Protocols
MH  - Combined Modality Therapy
MH  - Disease Progression
MH  - Drug Resistance
MH  - Female
MH  - Follow-Up Studies
MH  - Hematopoietic Stem Cell Transplantation
MH  - Humans
MH  - Immunoglobulin Light Chains/*metabolism
MH  - Immunoglobulin Light-chain Amyloidosis
MH  - Male
MH  - Middle Aged
MH  - Recurrence
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2017/03/18 06:00
MHDA- 2017/07/25 06:00
CRDT- 2017/03/18 06:00
PHST- 2017/01/23 00:00 [received]
PHST- 2017/03/13 00:00 [revised]
PHST- 2017/03/14 00:00 [accepted]
PHST- 2017/03/18 06:00 [pubmed]
PHST- 2017/07/25 06:00 [medline]
PHST- 2017/03/18 06:00 [entrez]
AID - 10.1002/ajh.24723 [doi]
PST - ppublish
SO  - Am J Hematol. 2017 Jun;92(6):549-554. doi: 10.1002/ajh.24723. Epub 2017 Apr 26.