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Outcome of AL amyloidosis after high-dose melphalan and autologous stem cell transplantation in Sweden, long-term results from all patients treated in 1994-2009.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
South Elvsborg Hosp, Dept Hematol, Boras, Sweden.
Karolinska Inst, Dept Hematol, Stockholm, Sweden.
Norrlands Univ Hosp, Dept Hematol, Umeå, Sweden.
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2016 (English)In: Bone Marrow Transplantation, ISSN 0268-3369, E-ISSN 1476-5365, Vol. 51, no 12, 1569-1572 p.Article in journal (Refereed) Published
Abstract [en]

High-dose melphalan and autologous stem cell transplantation (HDM/ASCT) is widely used in immunoglobulin light chain (AL) amyloidosis, but the benefit is debated mainly because of the high treatment-related mortality (24% in a randomised study comparing HDM/ASCT with oral melphalan/dexamethasone). We report here on the long-term outcome of all patients treated with HDM/ASCT for AL amyloidosis in Sweden between 1994 and 2009. Seventy-two patients were treated at eight Swedish centres. Median follow-up was 67.5 months. At least partial response (organ or haematological) was seen in 64% of the patients. Median overall survival was 98 months or 8.2 years, with 5-year survival 63.9% and 10-year survival 43.4%. In patients with cardiac involvement or multiple organ involvement, survival was significantly shorter, median overall survival 49 and 56 months, respectively. All mortality within 100 days from ASCT was 12.5% for all patients and 17.2% in the patients with cardiac involvement. For patients treated in the earlier time period (1994-2001), 100-day mortality was 23.8% compared with 7.8% in the later period (2002-2009). In conclusion, long survival times can be achieved in patients with AL amyloidosis treated with HDM/ASCT, also in smaller centres. Early mortality is high, but with a decreasing trend over time.

Place, publisher, year, edition, pages
2016. Vol. 51, no 12, 1569-1572 p.
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Medical and Health Sciences
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URN: urn:nbn:se:uu:diva-310948DOI: 10.1038/bmt.2016.249ISI: 000390759600005PubMedID: 27694943OAI: oai:DiVA.org:uu-310948DiVA: diva2:1058239
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2017-02-06Bibliographically approved

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Rosengren, SaraCarlson, Kristina

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