From CyBorD to dara-CyBorD, ASCT utilization trends in AL amyloidosis: a 15-year analysis

From CyBorD to dara-CyBorD, ASCT utilization trends in AL amyloidosis: a 15-year analysis

Abstract: This retrospective analysis examined 15 years of autologous stem cell transplantation (ASCT) for light chain (AL) amyloidosis at the Mayo Clinic (2010-2024). We aimed to assess ASCT utilization trends, factors influencing practice changes, and current indications amid newer therapies. Four...

Full description

Saved in:
Bibliographic Details
Main Authors: Eli Muchtar, Angela Dispenzieri, Francis K. Buadi, Prashant Kapoor, David Dingli, Taxiarchis V. Kourelis, Wilson Gonsalves, Nelson Leung, Suzanne R. Hayman, Martha Q. Lacy, Mustaqeem Siddiqui, Joselle Cook, Nadine Abdallah, Moritz Binder, Saurabh Zanwar, William Hogan, Rahma Warsame, S. Vincent Rajkumar, Shaji K. Kumar, Morie A. Gertz
Format: Article
Language:English
Published: Elsevier 2025-08-01
Series:Blood Advances
Online Access:http://www.sciencedirect.com/science/article/pii/S2473952925003672
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract: This retrospective analysis examined 15 years of autologous stem cell transplantation (ASCT) for light chain (AL) amyloidosis at the Mayo Clinic (2010-2024). We aimed to assess ASCT utilization trends, factors influencing practice changes, and current indications amid newer therapies. Four hundred and forty-one ASCTs were divided into cohort 1 (2010-2019) and cohort 2 (2020-2024), revealing a significant ASCT reduction in cohort 2 (385 vs 56, average 71% annual decrease). Cohort 2 patients were older, more likely to have relapsed/refractory disease, and had higher baseline bone marrow plasma cell burden compared to cohort 1. Pre-ASCT induction was more frequent in cohort 2 (89.3% vs 56.4%), with daratumumab (Dara)–cyclophosphamide-bortezomib-dexamethasone (CyBorD) replacing CyBorD as the predominant induction regimen. Lymphoma-based regimens were also more common in cohort 2 (15.1% vs 5.3%, P = .02). Day-100 satisfactory hematological response improved in cohort 2 (91.1% vs 72.7%, P = .001), although hematological complete response rates did not significantly differ (50.9% vs 38.8%, P = .09). In summary, there is a decrease in the utilization of ASCT in AL amyloidosis. This procedure is primarily reserved for patients with suboptimal responses, relapsed/refractory disease, lymphoplasmacytic clones (predominantly immunoglobulin M amyloidosis), or high bone marrow plasma cell burden (myeloma phenotype). This study underscores a significant shift in ASCT practice, driven by novel therapies, emphasizing more personalized management in AL amyloidosis.
ISSN:2473-9529

Similar Items