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Autologous stem cell transplant after heart transplant for light chain (Al) amyloid cardiomyopathy.

Lacy, MQ; Dispenzieri, A; Hayman, SR; Kumar, S; Kyle, RA; Rajkumar, SV; Edwards, BS; ... Gertz, MA; + view all (2008) Autologous stem cell transplant after heart transplant for light chain (Al) amyloid cardiomyopathy. J Heart Lung Transplant , 27 (8) pp. 823-829. 10.1016/j.healun.2008.05.016.

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Abstract

BACKGROUND: Historically, patients with AL amyloidosis and overt congestive heart failure have had an ominous prognosis with median survival of approximately 6 months. METHODS: Between 1994 and 2005, 11 patients underwent sequential orthotopic heart transplantation (HT) followed by autologous peripheral blood stem cell transplantation (SCT) for treatment of AL amyloidosis. Patients were accepted for this approach if they had heart-dominant AL with minimal/no other organ impairment and no evidence of multiple myeloma. Conditioning chemotherapy consisted of melphalan 200 mg/m(2) (6 patients) or melphalan 140 mg/m(2) (5 patients). RESULTS: Two patients died of complications from the SCT (18% transplant-related mortality). Nine patients survived both the HT and the SCT. Three patients subsequently died from progressive amyloidosis at 66, 56.7 and 55 months after SCT. The 1- and 5-year survival for HT was 82% and 65%. The median survival was 76 months from HT and 57 months from SCT. CONCLUSIONS: These data suggest that aggressive treatment of the underlying plasma cell clone after HT may improve long-term outcomes in patients with cardiac amyloid. HT followed by SCT is feasible and offers the possibility of remission for carefully selected patients with cardiac amyloidosis.

Type: Article
Title: Autologous stem cell transplant after heart transplant for light chain (Al) amyloid cardiomyopathy.
Location: United States
DOI: 10.1016/j.healun.2008.05.016
Keywords: Adult, Amyloidosis, Bacteremia, Cardiomyopathies, Female, Heart Transplantation, Humans, Immunoglobulin Light Chains, Immunosuppression, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Opportunistic Infections, Peripheral Blood Stem Cell Transplantation, Retrospective Studies, Treatment Outcome
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Pre-clinical and Fundamental Science
URI: http://discovery.ucl.ac.uk/id/eprint/1373712
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