The Impact of Melphalan Conditioning Schedule on Post-Transplant Outcomes in AL Amyloidosis: A Multicenter Study with 1718 Patients

• Published in: Blood 2023-11, Vol.142 (Supplement 1), p.4784-4784
• Main Authors: Muchtar, Eli, Sanchorawala, Vaishali, Hassan, Hamza, Hegenbart, Ute, Schonland, Stefan, Lee, Hans C., Qazilbash, Muzaffar H., Kin, Andrew, Houde, Christiane A., Buadi, Francis, Dispenzieri, Angela, Jacob, Eapen K., Arai, Sally, MD, Michelle Chin, Chakraborty, Rajshekhar, Lentzsch, Suzanne, Magen, Hila, Shkury, Eden, Sarubbi, Caitlin, Landau, Heather, Gertz, Morie A
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2023-188115

Introduction: High dose chemotherapy and autologous stem cell transplantation (ASCT) is one of the most effective therapies in light chain (AL) amyloidosis. It is associated with a high hematologic response rate and leads to durable remissions. High dose melphalan is the most frequently used conditioning chemotherapy, as has been used in multiple myeloma (MM). Melphalan dose is based on renal function, age, degree of cardiac involvement and patients' frailty and is predictive of outcomes. While studies that assessed the conditioning schedule have been conducted in MM, with variable results, no such studies were done in AL amyloidosis. Methods: In this retrospective study, we explored the impact of the conditioning schedule on post-transplant outcomes in a large multicenter study. Patients with AL amyloidosis who underwent ASCT for the primary diagnosis of AL amyloidosis between January 1, 2003, and December 31, 2020, were included in this study. Results: One thousand seven hundred and eighteen (n=1718) patients from 9 centers are included. The median age was 58 years, and 61% were male. Most patients had one (43%) or two (33%) involved organs, with the most involved organs were the kidneys (69%) followed by the heart (52%). Induction therapy was given to 52% of patients. The conditioning regimen was almost exclusively melphalan (99.2%), with 65% receiving full dose melphalan (≥170 mg/m 2). Melphalan was given over two days in most patients (80%). A rest day between conditioning and stem cell infusion was provided in 53% of patients, mostly in those who received melphalan on a single day rather than over 2 days (87% vs 44%, P