Impact of early response on outcomes in AL amyloidosis following treatment with frontline Bortezomib
Abstract The outcomes in systemic AL amyloidosis are dependent on the depth of haematologic response. However, there is limited data on the impact of the speed of response on outcomes. Here we report the impact of speed of response in a cohort of AL patients treated with upfront Bortezomib. Patients...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Publishing Group
2021-06-01
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| Series: | Blood Cancer Journal |
| Online Access: | https://doi.org/10.1038/s41408-021-00510-7 |
| _version_ | 1819083603401768960 |
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| author | Sriram Ravichandran Oliver C. Cohen Steven Law Darren Foard Marianna Fontana Ana Martinez-Naharro Carol Whelan Julian D. Gillmore Helen J. Lachmann Sajitha Sachchithanantham Shameem Mahmood Philip N. Hawkins Ashutosh D. Wechalekar |
| author_facet | Sriram Ravichandran Oliver C. Cohen Steven Law Darren Foard Marianna Fontana Ana Martinez-Naharro Carol Whelan Julian D. Gillmore Helen J. Lachmann Sajitha Sachchithanantham Shameem Mahmood Philip N. Hawkins Ashutosh D. Wechalekar |
| author_sort | Sriram Ravichandran |
| collection | DOAJ |
| description | Abstract The outcomes in systemic AL amyloidosis are dependent on the depth of haematologic response. However, there is limited data on the impact of the speed of response on outcomes. Here we report the impact of speed of response in a cohort of AL patients treated with upfront Bortezomib. Patients seen from February 2010 until August 2019 are included in the present analysis. 1194 & 1133 patients comprised the ITT and 1-month landmark cohorts. In the landmark cohort, 137 (11.5%), 270 (22.6%), 252 (21.1%) and 352 (31.1%) patients had a CR, VGPR, PR and NR at 1-month. Patients with ≥ VGPR at 1-month had significantly better survival (median not reached; at the end of 1, 2, 5,10 years, 87%/92%, 83%/87%, 68%/72% and 63%/58% of patients in CR/VGPR, respectively, were alive) compared to those with a PR (median OS 60 months) or NR (median OS 32 months) (p < 0.005). At 1-month, patients with CR and iFLC < 20 mg/l had a significantly better survival compared to CR and iFLC > 20 mg/l (p = 0.005). Reaching ≥ VGPR at 1-month significantly improved survival in all Mayo disease stages. In conclusion, patients achieving an early deep haematologic response have a significantly superior survival irrespective of cardiac involvement. |
| first_indexed | 2024-12-21T20:35:11Z |
| format | Article |
| id | doaj.art-b337fd1300e6447c92566346cf8407bf |
| institution | Directory Open Access Journal |
| issn | 2044-5385 |
| language | English |
| last_indexed | 2024-12-21T20:35:11Z |
| publishDate | 2021-06-01 |
| publisher | Nature Publishing Group |
| record_format | Article |
| series | Blood Cancer Journal |
| spelling | doaj.art-b337fd1300e6447c92566346cf8407bf2022-12-21T18:51:08ZengNature Publishing GroupBlood Cancer Journal2044-53852021-06-011161910.1038/s41408-021-00510-7Impact of early response on outcomes in AL amyloidosis following treatment with frontline BortezomibSriram Ravichandran0Oliver C. Cohen1Steven Law2Darren Foard3Marianna Fontana4Ana Martinez-Naharro5Carol Whelan6Julian D. Gillmore7Helen J. Lachmann8Sajitha Sachchithanantham9Shameem Mahmood10Philip N. Hawkins11Ashutosh D. Wechalekar12National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)National Amyloidosis Centre, University College London (Royal Free Campus)Abstract The outcomes in systemic AL amyloidosis are dependent on the depth of haematologic response. However, there is limited data on the impact of the speed of response on outcomes. Here we report the impact of speed of response in a cohort of AL patients treated with upfront Bortezomib. Patients seen from February 2010 until August 2019 are included in the present analysis. 1194 & 1133 patients comprised the ITT and 1-month landmark cohorts. In the landmark cohort, 137 (11.5%), 270 (22.6%), 252 (21.1%) and 352 (31.1%) patients had a CR, VGPR, PR and NR at 1-month. Patients with ≥ VGPR at 1-month had significantly better survival (median not reached; at the end of 1, 2, 5,10 years, 87%/92%, 83%/87%, 68%/72% and 63%/58% of patients in CR/VGPR, respectively, were alive) compared to those with a PR (median OS 60 months) or NR (median OS 32 months) (p < 0.005). At 1-month, patients with CR and iFLC < 20 mg/l had a significantly better survival compared to CR and iFLC > 20 mg/l (p = 0.005). Reaching ≥ VGPR at 1-month significantly improved survival in all Mayo disease stages. In conclusion, patients achieving an early deep haematologic response have a significantly superior survival irrespective of cardiac involvement.https://doi.org/10.1038/s41408-021-00510-7 |
| spellingShingle | Sriram Ravichandran Oliver C. Cohen Steven Law Darren Foard Marianna Fontana Ana Martinez-Naharro Carol Whelan Julian D. Gillmore Helen J. Lachmann Sajitha Sachchithanantham Shameem Mahmood Philip N. Hawkins Ashutosh D. Wechalekar Impact of early response on outcomes in AL amyloidosis following treatment with frontline Bortezomib Blood Cancer Journal |
| title | Impact of early response on outcomes in AL amyloidosis following treatment with frontline Bortezomib |
| title_full | Impact of early response on outcomes in AL amyloidosis following treatment with frontline Bortezomib |
| title_fullStr | Impact of early response on outcomes in AL amyloidosis following treatment with frontline Bortezomib |
| title_full_unstemmed | Impact of early response on outcomes in AL amyloidosis following treatment with frontline Bortezomib |
| title_short | Impact of early response on outcomes in AL amyloidosis following treatment with frontline Bortezomib |
| title_sort | impact of early response on outcomes in al amyloidosis following treatment with frontline bortezomib |
| url | https://doi.org/10.1038/s41408-021-00510-7 |
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