High-dose melphalan and autologous stem cell transplantation increases survival
October 26, 2011 in CancerA team of researchers led by Boston University School of Medicine (BUSM), has found treatment of selected immunoglobulin light chain (AL) amyloidosis patients with high-dose melphalan and autologous stem cell transplantation (HDM/SCT) resulted in a high organ response rate and increased overall survival (OS), even for those patients who did not achieve a hematologic complete response (CR). These findings appear in the current issue of Blood.
AL amyloidosis is the most common form of systemic amyloidosis, with an incidence of five to 12 persons per million per year. In AL amyloidosis, clonal bone marrow plasma cells produce monoclonal light chains that misfold and deposit in tissues and organs as amyloid fibrils, resulting in progressive system and organ failure and ultimately in death.
Untreated patients with this disease have a dismal outcome, with a median survival of 10-14 months from diagnosis. Moreover, fewer than five percent of patients survived for 10 years before the introduction of HDM/SCT.
The BUSM researchers analyzed a series of 421 patients treated with HDM/SCT and compared outcomes for patients with and without CR. Treatment related mortality was 11.4 percent overall (5.6 percent in the last 5 years). The CR rate was 34 percent and the median event-free survival (EFS) and OS were 2.6 and 6.3 years, respectively.
Eighty-one patients died within the first year after HDM/SCT and were not evaluable for hematologic and organ response. Of 340 evaluable patients, 43 percent achieved CR and 78 percent of them experienced an organ response. For CR patients, median EFS and OS were 8.3 and 13.2 years, respectively. Among the 195 patients who did not obtain CR, 52 percent achieved an organ response, and their median EFS and OS were 2 and 5.9 years, respectively.
"This study provides the longest outcome data on AL patients treated with HDM/SCT, including OS, EFS, and long-term mortality," explained senior author Martha Skinner, MD, former director of BUSM's Amyloid Treatment and Research Program as well as a professor of medicine at BUSM. "Our results demonstrate that, with careful patient selection and experienced management, low rates of treatment related mortality can be achieved.
According to the authors, despite the importance of attaining CR, achievement of partial response often results in a long period of stable or improved diseases. "We pioneered HDM/SCT treatment for AL amyloidosis in 1994. This long term review shows durable hmetologic and organ responses for most patients with an overall survival greatly exceeding what it was prior to HDM/SCT treatment," she added.
Provided by Boston University Medical Center
-
Donor stem cell transplantation associated with survival benefit for patients with leukemia
Jun 10, 2009 |
not rated yet |
0
-
Hodgkin's lymphoma: Benefit of stem cell transplantation with an unrelated donor unclear
Sep 29, 2010 |
not rated yet |
0
-
One step closer in finding treatment for amyloidosis
Oct 21, 2010 |
not rated yet |
0
-
Asian lung cancer patient survival exceeds Caucasians' on multiple regimens
Jun 01, 2011 |
not rated yet |
0
-
Intense chemotherapy wards off recurrence in half of mantle cell lymphoma patients after seven years
Dec 09, 2008 |
not rated yet |
0
-
Of mice and mental models: Neuroscientific implications of risk-optimized behavior in the mouse
May 25, 2012 |
not rated yet |
0
-
Limits to growth: Scientists identify key metastasis-enabling enzyme
May 22, 2012 |
5 / 5 (4) |
0
-
Seeing is as seeing does: Spatially-structured retinal input in early development of cortical maps
Apr 26, 2012 |
5 / 5 (4) |
1
-
Dreamless nights: Brain activity during nonrapid eye movement sleep
Apr 09, 2012 |
4.4 / 5 (12) |
0
-
Take your time: Neurobiology sheds light on the superiority of spaced vs. massed learning
Mar 28, 2012 |
4.5 / 5 (21) |
3
-
Potential Breakthrough in Seizure Control
7 hours ago
-
Popping/Cracked sternum.
11 hours ago
-
Which Mental Illness Encompasses This Problem?
12 hours ago
-
A question about drug tolerance
May 23, 2012
-
Poor nutrition leading to overeating?
May 23, 2012
-
Math and dyslexia?
May 21, 2012
- More from Physics Forums - Medical Sciences
More news stories
Skp2 activates cancer-promoting, glucose-processing Akt
HER2 and its epidermal growth factor receptor cousins mobilize a specialized protein to activate a major player in cancer development and sugar metabolism, scientists report in the May 25 issue of Cell.
Cancer
19 hours ago |
not rated yet |
0
|
Pancreatectomy OK without downstaging from therapy
(HealthDay) -- Pancreatectomy improves median survival in pancreatic cancer patients even when presurgical neoadjuvant therapy does not lead to radiographic downstaging of tumors, according to a study published ...
Cancer
20 hours ago |
not rated yet |
0
Common therapies for basal cell carcinoma offer similar survival
(HealthDay) -- For patients with superficial basal cell carcinoma (sBCC), treatment with imiquimod or photodynamic therapy (PDT) results in similar long-term tumor-free survival, according to a review published ...
Cancer
21 hours ago |
not rated yet |
0
Cancer may require simpler genetic mutations than previously thought
Chromosomal deletions in DNA often involve just one of two gene copies inherited from either parent. But scientists haven't known how a deletion in one gene from one parent, called a "hemizygous" deletion, can contribute ...
Cancer
23 hours ago |
not rated yet |
0
|
New prostate cancer screening guidelines face a tough sell, study suggests
(Medical Xpress) -- Recent recommendations from the U.S. Preventive Services Task Force (USPSTF) advising elimination of routine prostate-specific antigen (PSA) screening for prostate cancer in healthy men are likely to encounter ...
Cancer
May 25, 2012 |
not rated yet |
1
Family history of Alzheimer's affects functional connectivity
(HealthDay) -- Cognitively normal individuals with a family history of late-onset Alzheimer's disease (AD) may display lower resting state functional connectivity in the default mode network (DMN) of the brain, ...
Travel to high altitudes tied to Crohn's, colitis flare-ups
(HealthDay) -- People with inflammatory bowel disease, which includes Crohn's disease and colitis, may be at increased risk for flare-ups when they fly or travel to high altitudes for skiing or mountain climbing, ...
Transvaginal mesh op restores pelvic organ prolapse at price
(HealthDay) -- Transvaginal mesh (TVM) procedures are effective for anatomical restoration of pelvic organ prolapse (POP), but patients report a worsening of sexual function following surgery, according to ...
Inherited DNA change explains overactive leukemia gene
A small inherited change in DNA is largely responsible for overactivating a gene linked to poor treatment response in people with acute leukemia.
Tongue analysis software uses ancient Chinese medicine to warn of disease
For 5,000 years, the Chinese have used a system of medicine based on the flow and balance of positive and negative energies in the body. In this system, the appearance of the tongue is one of the measures used to classify ...
Early physical therapist treatment associated with reduced risk of healthcare utilization and reduced overall healthcare
A new study published in Spine shows that early treatment by a physical therapist for low back pain (LBP), as compared to delayed treatment, was associated with reduced risk of subsequent healthcare utilization and lower ...