Efficacy of Chemotherapies and Stem Cell Transplantation for Systemic AL Amyloidosis: A Network Meta-Analysis

Cai, Yiran; Xu, Shiqi; Li, Na; Li, Song; Xu, Gaosi

doi:10.3389/fphar.2019.01601

Cited by 5 publications

(3 citation statements)

References 34 publications

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“…A regimen including bortezomib, a proteasome inhibitor, with or without corticosteroids, is a highly efficacious alternative to HCT. 15,16 Options for disease that has relapsed or is refractory to initial therapy include daratumumab, an anti-CD38 monoclonal antibody, proteasome inhibitor regimens, or immunomodulatory regimens. 17 The choice of therapy is decided on according to patient-specific disease and social factors, some of which may be linked to a more favorable response to certain therapies.…”

Section: Discussionmentioning

confidence: 99%

First Case of Nodular Localized Primary Cutaneous Amyloidosis Treated With Bortezomib and Dexamethasone

Khan

Nellhaus

Griswold

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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Nodular localized cutaneous amyloidosis is a rare form of cutaneous amyloidosis and is characterized by an extracellular deposition of insoluble amyloid fibrils which are either primarily cutaneous or a manifestation of an underlying systemic amyloidosis. Biopsy of the lesion is mandatory for the diagnosis, and histopathology shows diffuse amyloid deposits with plasmacytic infiltration. Apple-green birefringence characteristic of amyloidosis is observed when stained with Congo red and viewed under polarized light. Amyloid subtyping is done with laser microdissection followed by mass spectrometry. Majority of these lesions do not require any treatment but surgical excision, shave excision, laser therapy, and radiotherapy can be considered for symptomatic nodular localized primary cutaneous amyloidosis (NLPCA). We present a case of recurrent NLPCA in a 64-year-old woman who was treated with bortezomib and dexamethasone after failing several local therapies with excellent response.

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Section: Discussionmentioning

confidence: 99%

First Case of Nodular Localized Primary Cutaneous Amyloidosis Treated With Bortezomib and Dexamethasone

Khan

Nellhaus

Griswold

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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“…A meta-analysis involving three randomized controlled trials (RCTs) and thirteen observational controlled trials (OCTs) comparing seven treatment regimens: High dose melphalan followed by autologous stem cell transplant (HDM/HSCT), Melphalan + dexamethasone (MDex), Bortezomib + melphalan + dexamethasone (BMDex), Bortezomib + dexamethasone (BDex), Thalidomide + cyclophosphamide + dexamethasone (CTD), Bortezomib + Cyclophosphamide + dexamethasone (CyBorD), cyclophosphamide + lenalidomide + dexamethasone (CLD) showed BMDex ranking high in terms of hematologic response and complete response (CR), CTD ranking high in terms of renal response and BDex was best treatment for cardiac response [ 31 ].…”

Section: Indications For Systemic Therapymentioning

confidence: 99%

Systemic AL amyloidosis: current approach and future direction

et al. 2023

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Systemic Light chain (AL) amyloidosis is a monoclonal plasma cell proliferative disorder characterized by deposition of amyloidogenic monoclonal light chain fragments causing organ dysfunction. It is a fatal disease and if not diagnosed and treated early can lead to organ failure and potentially death. The renal system along with the cardiovascular system are the most common organs involved but other organs such as gut and liver can be involved as well. The initial evaluation of patients requires confirming the diagnosis with tissue biopsy and staining with Congo red followed by confirmatory typing with mass spectrometry of the Congo red positive tissue. Then establishing the extent of the organs involvement by various staging and biomarkers testing. The treatment options and the tolerability of therapy depend on the disease staging, frailty, and co-morbidities. The autologous hematopoietic cell transplantation (HCT) after high dose melphalan therapy is an effective strategy which is usually done after initial bortezomib induction therapy. Unfortunately, most systemic AL amyloidosis patients are not candidate for HCT due to frailty, old age, multi-organ involvement, renal and heart failure at the time of diagnosis. While it is widely accepted that the patients need to be treated until they achieve complete hematologic response, the maintenance therapy after HCT is not well established in AL amyloidosis. In this review, we report the literature on the latest treatment updates of AL amyloidosis and the ongoing clinical trials highlighting the future treatments.

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“…18,19 A retrospective study from our own center also showed that CTD was an effective and safe option for treating AL patients with renal involvement. 20 A recently published network meta-analysis 21 concluded that CTD could induce the highest rate of renal response and BDex was associated with highest cardiac response rate. There has been a retrospective comparison of cyclophosphamide, bortezomib, and dexamethasone versus CTD, 16 but no direct comparison of BDex and CTD has been reported.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of cyclophosphamide, thalidomide and dexamethasone (CTD) versus bortezomib and dexamethasone (BDex) in light-chain amyloidosis

Liu

Wang

Ning

et al. 2020

Preprint

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Background: Cyclophosphamide, thalidomide and dexamethasone (CTD) or bortezomib and dexamethasone (BDex) show substantial efficacy in patients with amyloid light-chain (AL) amyloidosis, especially in Chinese patients. Currently, both regimens are recommended as primary treatment options for AL amyloidosis, but no comparative study has been reported. Results: We retrospectively evaluated the outcomes of 81 AL patients who received CTD (n=42) or BDex (n=39) and used Mayo stage 2012 to match 26 pairs of patients. In the whole cohort, the overall hematologic responses were 86% vs 91% in the CTD and BDex groups, including a complete response of 56% vs 71% based on an intention-to-treat (ITT) analysis. One- and two-year overall survival (OS) was 90.2% and 81.7% with CTD, and 87.6% and 82.7% with BDex. After matching, BDex regimen induced a significantly deeper and more rapid hematologic response over CTD, but no statistically significant difference in OS (ITT analysis, P =0.24; 6-month landmark analysis, P =0.48). Cardiac response rates were similar, while there was a trend for higher renal responses in patients treated with BDex (68% vs 44%, P =0.09). Additionally, BDex was associated with significantly improved survival in patients with advanced disease (Mayo stage III or worse) ( P =0.009). Patients treated with BDex reported more episodes of severe hematologic toxicity and diarrhea. Conclusions: CTD and BDex are effective treatments for Chinese patients with AL amyloidosis, but BDex regimen appears superior to CTD in achieving a more rapid and deeper clonal response, and in improving OS in patients with advanced disease.

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Efficacy of Chemotherapies and Stem Cell Transplantation for Systemic AL Amyloidosis: A Network Meta-Analysis

Cited by 5 publications

References 34 publications

First Case of Nodular Localized Primary Cutaneous Amyloidosis Treated With Bortezomib and Dexamethasone

First Case of Nodular Localized Primary Cutaneous Amyloidosis Treated With Bortezomib and Dexamethasone

Systemic AL amyloidosis: current approach and future direction

A comparative study of cyclophosphamide, thalidomide and dexamethasone (CTD) versus bortezomib and dexamethasone (BDex) in light-chain amyloidosis

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