First Line Therapy With Cyclophosphamide, Bortezomib and Dexamethasone (CyBorD) In Patients With AL Amyloidosis and Potentially Reversible Contraindications To Autologous Stem Cell Transplant
| Autor: | Marta Vidus Rosin, Giovanni Palladini, Giampaolo Merlini, Paolo Milani, Andrea Foli |
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| Rok vydání: | 2013 |
| Předmět: | |
| Zdroj: | Blood. 122:1985-1985 |
| ISSN: | 1528-0020 0006-4971 |
| DOI: | 10.1182/blood.v122.21.1985.1985 |
| Popis: | Two recent reports by the Mayo Clinic and UK groups showed that the combination of cyclophosphamide, bortezomib, and dexamethasone (CyBorD) grants a high rate of complete response (CR) and very good partial response (VGPR) in AL amyloidosis. In the two papers a total of 30 patients who received CyBorD upfront were reported, 63% of whom achieved CR. This combination has the further advantage of sparing stem cells, allowing second-line autologous stem cell transplant (ASCT). In the present study we treated with frontline CyBorD 56 consecutive newly diagnosed patients with AL amyloidosis, diagnosed between 2010 and 2012, who were transplant candidates and refused the procedure frontline or had potentially reversible contraindications to ASCT. Main exclusion criteria from the present study were age ≥70 years, NT-proBNP >8500 ng/L, systolic blood pressure This is the largest study on frontline CyBorD in AL amyloidosis reported so far. In this homogeneous patient population including low/intermediate-risk subjects with potentially reversible contraindication to ASCT, 43% of patients achieved CR/VGPR and cardiac dysfunction improved in one third of cases. Second-line ASCT was feasible in subjects with suboptimal responses. Though good, the response rate to CyBorD observed in the present study was lower than that reported in the 2 previously published studies, indicating that randomized clinical trials are needed to assess the efficacy of this combination in AL amyloidosis. Disclosures: Off Label Use: Bortezomib in AL amyloidosis. Merlini:Millennium-Takeda: Honoraria; Pfizer: Honoraria. |
| Databáze: | OpenAIRE |
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