2020
DOI: 10.1159/000506498
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High-Dose Melphalan and Autologous Peripheral Blood Stem Cell Transplantation in AL Amyloidosis

Abstract: AL amyloidosis is a systemic amyloidosis and is associated with an underlying plasma cell dyscrasia. High-dose intravenous melphalan and autologous stem cell transplantation was developed for the treatment of AL amyloidosis in the early 1990s and was prompted by its success in myeloma. This application has evolved significantly over the past three decades. This review provides a comprehensive assessment of eligibility criteria, stem cell collection, and mobilization strategies and regimens, risk-adapted melpha… Show more

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Cited by 20 publications
(15 citation statements)
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“…Despite an evolving therapeutic landscape for AL amyloidosis, HDM/SCT remains one of the most effective treatments available 40,41 . In our study, racial/ethnic minorities were less likely to receive treatment with HDM/SCT, with Hispanics in particular having a 30% lower likelihood compared to NHWs.…”
Section: Discussionmentioning
confidence: 99%
“…Despite an evolving therapeutic landscape for AL amyloidosis, HDM/SCT remains one of the most effective treatments available 40,41 . In our study, racial/ethnic minorities were less likely to receive treatment with HDM/SCT, with Hispanics in particular having a 30% lower likelihood compared to NHWs.…”
Section: Discussionmentioning
confidence: 99%
“…The first stage in the management of toxicity in relation to ASCT is during stem cell mobilization and collection whereby low serum albumin, elevated NT-proBNP and increased septal thickening were found to be important risk factors for toxicity 34 , 35 During stem cell mobilization, patients can experience various toxicities including tachyarrhythmias, thromboembolic events, weight gain (due to fluid retention), bleeding, acute kidney injury, hypertensive crises, or hypotension. To minimize risk of toxicity, it is recommended to use granulocyte-colony-stimulating factor (G-CSF) without cyclophosphamide given the increased cardiac morbidity, significantly higher number of apheresis required, increased hospitalizations and increased toxicity associated with the latter 36 . The recommended dose of G-CSF is 10–16 μg/kg/day, either as one dose or divided into two doses, 3 days before stem cell collection for an optimal total of at least 5 × 10 6 CD34+ cells/kg 37 .…”
Section: Treatment Of Asct-eligible Patientsmentioning
confidence: 99%
“…The general recommendation though, is to split the dose. If patients fail stem cell mobilization, plerixafor is a well-tolerated adjuvant 36 .…”
Section: Treatment Of Asct-eligible Patientsmentioning
confidence: 99%
“…High-dose intravenous melphalan and autologous SCT was developed for the treatment of AL amyloidosis in the early 1990s and was prompted by its success in myeloma. 3 This application has evolved significantly over the past 3 decades. These guidelines provide a comprehensive assessment of eligibility criteria, stem cell collection and mobilization strategies and regimens, risk-adapted melphalan dosing, role for induction and consolidation therapies, specific supportive care management, long-term outcome with respect to survival, hematologic response and relapse, and organ responses following SCT.…”
mentioning
confidence: 99%