Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

A second autologous hematopoietic cell transplantation is a safe and effective salvage therapy in select relapsed or refractory AL amyloidosis patients

Bone Marrow Transplantation volume 57, pages 295–298 (2022)Cite this article

Subjects

To the Editor:

Systemic light chain (AL) amyloidosis is a rare plasma cell neoplasm caused by misfolded protein deposition resulting in organ dysfunction. High-dose melphalan with autologous hematopoietic cell transplant (AHCT) has led to significant improvements in outcomes in transplant-eligible patients with deep hematologic complete response (CR) and organ response rates, and excellent overall survival (OS) [1]. With improved supportive care and careful patient selection, day-100 transplant-related mortality (D100 TRM) rate has decreased to 2–5% in recent years in large-database studies in the US [1, 2]. Although patients who achieve hematologic CR have high organ responses and longer survival, the underlying plasma cell neoplasm remains incurable, leading to disease recurrence and/or relapse. In multiple myeloma (MM), a second AHCT (AHCT2) can improve progression-free survival (PFS) and OS compared to conventional chemotherapy [3, 4]. Large amyloid centers have reported single-center series of patients who received AHCT2 for relapsed disease [5, 6]. However, the extent to which this intervention is being utilized and its outcomes with respect to safety and long-term survival are unknown. We used the Center for International Blood and Marrow Transplant Research® (CIBMTR®) database to evaluate the safety and outcomes associated with AHCT2 in relapsed/refractory AL amyloidosis.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Outcomes of patients after AHCT2 in AL amyloidosis.

Data sharing

CIBMTR supports the accessibility of research in accord with the National Institutes of Health (NIH) Data Sharing Policy and the National Cancer Institute (NCI) Cancer Moonshot Public Access and Data Sharing Policy. The CIBMTR only releases de-identified datasets that comply with all relevant global regulations regarding privacy and confidentiality.

References

  1. D’Souza A, Dispenzieri A, Wirk B, Zhang MJ, Huang J, Gertz MA, et al. Improved outcomes after autologous hematopoietic cell transplantation for light chain amyloidosis: a center for International Blood and Marrow Transplant Research Study. J Clin Oncol.2015;33:3741–9. https://doi.org/10.1200/JCO.2015.62.4015

    Article  Google Scholar 

  2. Cornell RF, Fraser R, Costa L, Goodman S, Estrada-Merly N, Lee C, et al. Bortezomib-based induction Is associated with superior outcomes in light chain amyloidosis patients treated with autologous hematopoietic cell transplantation regardless of plasma cell burden. Transpl Cell Ther. 2021;27:264 e261–264 e267. https://doi.org/10.1016/j.jtct.2020.11.018.

    Article  Google Scholar 

  3. Cook G, Ashcroft AJ, Cairns DA, Williams CD, Brown JM, Cavenagh JD, et al. The effect of salvage autologous stem-cell transplantation on overall survival in patients with relapsed multiple myeloma (final results from BSBMT/UKMF Myeloma X Relapse [Intensive]): a randomised, open-label, phase 3 trial. Lancet Haematol. 2016;3:e340–351. https://doi.org/10.1016/S2352-3026(16)30049-7.

    Article  Google Scholar 

  4. Dhakal B, D’Souza A, Kleman A, Chhabra S, Mohan M, Hari P. Salvage second transplantation in relapsed multiple myeloma. Leukemia. 2020;35:1214–17. https://doi.org/10.1038/s41375-020-1005-8.

  5. Muchtar E, Dispenzieri A, Kumar SK, Lacy MQ, Buadi FK, Dingli D, et al. Second stem cell transplantation for relapsed refractory light chain (AL) amyloidosis. Transpl Cell Ther. 2021;27:589 e581–589 e586. https://doi.org/10.1016/j.jtct.2021.03.031.

    Article  Google Scholar 

  6. Quillen K, Seldin DC, Finn KT, Sanchorawala V. A second course of high-dose melphalan and auto-SCT for the treatment of relapsed AL amyloidosis. Bone Marrow Transplant. 2011;46:976–80. https://doi.org/10.1038/bmt.2010.239.

    Article  CAS  Google Scholar 

  7. Gertz MA, Comenzo R, Falk RH, Fermand JP, Hazenberg BP, Hawkins PN, et al. Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis, Tours, France, 18-22 April 2004. Am J Hematol. 2005;79:319–28. https://doi.org/10.1002/ajh.20381

    Article  Google Scholar 

  8. Sidana S, Sidiqi MH, Dispenzieri A, Buadi FK, Lacy MQ, Muchtar E, et al. Fifteen year overall survival rates after autologous stem cell transplantation for AL amyloidosis. Am J Hematol. 2019;94:1020–6. https://doi.org/10.1002/ajh.25566.

    Article  CAS  Google Scholar 

  9. Kastritis E, Palladini G, Minnema MC, Wechalekar AD, Jaccard A, Lee HC, et al. Daratumumab-based treatment for immunoglobulin light-chain amyloidosis. N. Engl J Med. 2021;385:46–58. https://doi.org/10.1056/NEJMoa2028631.

    Article  CAS  Google Scholar 

  10. Cornell RF, Zhong X, Arce-Lara C, Atallah E, Blust L, Drobyski WR, et al. Bortezomib-based induction for transplant ineligible AL amyloidosis and feasibility of later transplantation. Bone Marrow Transplant. 2015;50:914–7. https://doi.org/10.1038/bmt.2015.73.

    Article  CAS  Google Scholar 

  11. Michaelis LC, Saad A, Zhong X, Le-Rademacher J, Freytes CO, Marks DI, et al. Salvage second hematopoietic cell transplantation in myeloma. Biol Blood Marrow Transplant. 2013;19:760–6. https://doi.org/10.1016/j.bbmt.2013.01.004.

    Article  Google Scholar 

Download references

Acknowledgements

The research reported in this publication was supported by K23 HL141445 (AD). The CIBMTR is supported primarily by Public Health Service U24CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); HHSH250201700006C from the Health Resources and Services Administration (HRSA); and N00014-20-1-2705 and N00014-20-1-2832 from the Office of Naval Research; support is also provided by Be the Match Foundation, the Medical College of Wisconsin, the National Marrow Donor Program, and from the following commercial entities: AbbVie; Actinium Pharmaceuticals, Inc.; Adaptive Biotechnologies Corporation; Adienne SA; Allovir, Inc.; Amgen, Inc.; Angiocrine Bioscience; Astellas Pharma US; Bluebird Bio, Inc.; Bristol Myers Squibb Co.; CSL Behring; CytoSen Therapeutics, Inc.; Daiichi Sankyo Co., Ltd.; Eurofins Viracor; ExcellThera; Fate Therapeutics; Gamida-Cell, Ltd.; Genentech Inc; GlaxoSmithKline; Incyte Corporation; Janssen/Johnson & Johnson; Jasper Therapeutics; Jazz Pharmaceuticals, Inc.; Karyopharm Therapeutics; Kiadis Pharma; Kite, a Gilead Company; Kyowa Kirin; Legend Biotech; Magenta Therapeutics; Medac GmbH; Merck & Co.; Millennium, the Takeda Oncology Co.; Miltenyi Biotec, Inc.; MorphoSys; Novartis Pharmaceuticals Corporation; Omeros Corporation; Oncoimmune, Inc.; Orca Biosystems, Inc.; Pfizer, Inc.; Pharmacyclics, LLC; Sanofi Genzyme; Seagen, Inc.; Stemcyte; Takeda Pharmaceuticals; Tscan; Vertex; Vor Biopharma; Xenikos BV.

Author information

Authors and Affiliations

  1. Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Carlyn Rose Tan

  2. CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Noel Estrada-Merly & Anita D’Souza

  3. Bone Marrow Transplant Service, Division of Hematology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Heather Landau

  4. University of Miami, Miami, FL, USA

    Lazaros Lekakis

  5. Division of Hematology-Oncology, University of California San Francisco, San Francisco, CA, USA

    Rahul Banerjee & Nina Shah

  6. McMaster University, Ontario, Canada

    Hira Mian

  7. Department of Hematologic Oncology & Blood Disorders Levine Cancer Institute/Atrium Health, Charlotte, NC, USA

    Saad Z. Usmani

  8. King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia

    Amr Hanbali

  9. University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Hillard M. Lazarus

  10. Mayo Clinic Rochester, Rochester, MN, USA

    Robert A. Kyle & Shaji Kumar

  11. Vanderbilt University Medical Center, Nashville, TN, USA

    Bhagirathbhai Dholaria

  12. University of Alabama at Birmingham, Birmingham, AL, USA

    Susan Bal

  13. Division of Hematology, Oncology, and Bone Marrow Transplantation, University of lowa, Iowa City, IA, USA

    Christopher Strouse

  14. Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA

    Hemant S. Murthy

  15. Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA, USA

    Baldeep Wirk

  16. Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, FL, USA

    Taiga Nishihori

  17. M.D. Anderson Cancer Center, Houston, TX, USA

    Muzaffar Qazilbash

Authors
  1. Carlyn Rose Tan
    View author publications

    Search author on:PubMed Google Scholar

  2. Noel Estrada-Merly
    View author publications

    Search author on:PubMed Google Scholar

  3. Heather Landau
    View author publications

    Search author on:PubMed Google Scholar

  4. Lazaros Lekakis
    View author publications

    Search author on:PubMed Google Scholar

  5. Rahul Banerjee
    View author publications

    Search author on:PubMed Google Scholar

  6. Hira Mian
    View author publications

    Search author on:PubMed Google Scholar

  7. Saad Z. Usmani
    View author publications

    Search author on:PubMed Google Scholar

  8. Amr Hanbali
    View author publications

    Search author on:PubMed Google Scholar

  9. Hillard M. Lazarus
    View author publications

    Search author on:PubMed Google Scholar

  10. Robert A. Kyle
    View author publications

    Search author on:PubMed Google Scholar

  11. Bhagirathbhai Dholaria
    View author publications

    Search author on:PubMed Google Scholar

  12. Susan Bal
    View author publications

    Search author on:PubMed Google Scholar

  13. Christopher Strouse
    View author publications

    Search author on:PubMed Google Scholar

  14. Hemant S. Murthy
    View author publications

    Search author on:PubMed Google Scholar

  15. Baldeep Wirk
    View author publications

    Search author on:PubMed Google Scholar

  16. Taiga Nishihori
    View author publications

    Search author on:PubMed Google Scholar

  17. Shaji Kumar
    View author publications

    Search author on:PubMed Google Scholar

  18. Nina Shah
    View author publications

    Search author on:PubMed Google Scholar

  19. Muzaffar Qazilbash
    View author publications

    Search author on:PubMed Google Scholar

  20. Anita D’Souza
    View author publications

    Search author on:PubMed Google Scholar

Contributions

CT, NE and AD designed the study, analyzed the data, interpreted the results and wrote the paper. HL, LL, RB, HM, SU, AH, HL, RK, BD, SB, CS, HM BW, TN, SK, NS and MQ reviewed the protocol and provided input, interpreted the analysis, and edited the paper. All authors approved the final draft.

Corresponding author

Correspondence to Anita D’Souza.

Ethics declarations

Competing interests

Dr. Dholaria reports institutional research support from Takeda, Janssen, Angiocrine, Pfizer, Poseida. Údvisory board for Jazz. Dr. Banerjee reports grants from Pack Health, personal fees from SparkCures, outside the submitted work. Dr. Mian reports grants from Janssen and consulting fees from Janssen, BMS, Takeda, Sanofi, Amgen, GSK. Personal fees from Amgen, Sanofi, BMS/Celgene, Janssen. Board of directors for Myeloma Canada. Dr. Tan reports other financial interests—spouse employed by Janssen R&D. Dr. Usmani reports grants and personal fees from Amgen, personal fees from Abbvie, grants from BMS, grants and personal fees from Celgene, personal fees from MundiPharma, grants from Pharmacyclics, grants and personal fees from Sanofi, grants and personal fees from Seattle Genetics, grants and personal fees from Janssen, grants and personal fees from Takeda, grants and personal fees from SkylineDX, grants and personal fees from Merck, grants and personal fees from GSK, outside the submitted work. Dr. Murthy reports board participation for CRISPR Therapeutics. Dr. Qazilbash reports data safety board participation for Autolus and the advisory board for Oncopeptides. Dr. Dholaria reports institutional research funds from Janssen, Poseida, Angiocrine, Takeda. Personal advisory funds from Jazz. Dr. Kumar reports institutional research support for clinical trials from Abbvie, Celgene, Janssen, Takeda, Adaptive, KITE, Medimmune/Astra Zeneca, Merck, Novartis, Roche, and Sanofi. Advisory board participation paid to the institution from Abbvie, Celgene, Janssen, Takeda, Adaptive, KITE, and Medimmune/Astra Zeneca and Oncopeptides independent review committee. Dr. Nishihori reports research support outside of the submitted work paid to the institution from Norvartis and Karyopharm. Dr. Strouse reports consulting fees from Bristol Meyer Squibb. Dr. Landau reports grant support from Takeda Pharmaceuticals, payment or honoraria from Genzyme corporation. Participation on board for Janssen, Genzyme, Celgene. Dr. D’Souza reports grant support from Takeda, TeneoBio, Sanofi, Caelum and Prothena, consulting fees from Janssen, and advisory board participation fees from Imbrium, Pfizer and BMS.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, C.R., Estrada-Merly, N., Landau, H. et al. A second autologous hematopoietic cell transplantation is a safe and effective salvage therapy in select relapsed or refractory AL amyloidosis patients. Bone Marrow Transplant 57, 295–298 (2022). https://doi.org/10.1038/s41409-021-01527-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41409-021-01527-z

This article is cited by

Search

Advanced search

Quick links