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The impact of melphalan conditioning and CD34+ cell dose and schedule on post-transplant outcomes in AL amyloidosis

The optimal conditioning schedule and CD34+ cell dose for autologous stem cell transplantation (ASCT) for AL amyloidosis is unknown. Patients (n = 1704) who underwent ASCT for AL amyloidosis between 2003 and 2020 in 9 centers were included. Data on melphalan conditioning dose, number of conditioning...

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Main Authors: Muchtar, Eli (Author) , Sanchorawala, Vaishali (Author) , Hassan, Hamza (Author) , Hegenbart, Ute (Author) , Schönland, Stefan (Author) , Lee, Hans C. (Author) , Qazilbash, Muzaffar (Author) , Kin, Andrew (Author) , Zonder, Jeffrey (Author) , Jacob, Eapen (Author) , Buadi, Francis (Author) , Dispenzieri, Angela (Author) , Dingli, David (Author) , Arai, Sally (Author) , Chin, Michelle (Author) , Chakraborty, Rajshekhar (Author) , Lentzsch, Suzanne (Author) , Magen, Hila (Author) , Shkury, Eden (Author) , Sarubbi, Caitlin (Author) , Landau, Heather (Author) , Gertz, Morie (Author)
Format: Article (Journal)
Language:English
Published: 2025
In: American journal of hematology
Year: 2025, Volume: 100, Issue: 7, Pages: 1141-1151
ISSN:1096-8652
DOI:10.1002/ajh.27685
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ajh.27685
Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ajh.27685
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Author Notes:Eli Muchtar, Vaishali Sanchorawala, Hamza Hassan, Ute Hegenbart, Stefan Schönland, Hans C. Lee, Muzaffar Qazilbash, Andrew Kin, Jeffrey Zonder, Eapen Jacob, Francis Buadi, Angela Dispenzieri, David Dingli, Sally Arai, Michelle Chin, Rajshekhar Chakraborty, Suzanne Lentzsch, Hila Magen, Eden Shkury, Caitlin Sarubbi, Heather Landau, Morie Gertz
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Summary:The optimal conditioning schedule and CD34+ cell dose for autologous stem cell transplantation (ASCT) for AL amyloidosis is unknown. Patients (n = 1704) who underwent ASCT for AL amyloidosis between 2003 and 2020 in 9 centers were included. Data on melphalan conditioning dose, number of conditioning days, whether a rest day between conditioning and stem cell infusion was given or not, and infused CD34+ cell dose were collected. Full-dose melphalan (≥ 180 mg/m2) was administered in 63.7% of the patients, and 80.4% had melphalan split into 2-day conditioning. A rest day (day −1) between the conditioning regimen and stem cell infusion was provided in 52.5% of patients. The median infused CD34+ cell count was 4.7 × 106/kg. An infused CD34+ cell count ≥ 4.5 × 106/kg was associated with a shorter time to neutrophil and platelet engraftment. In a nominal regression analysis, full-dose melphalan, 1-day melphalan conditioning, and omitting a rest day between conditioning and stem cell infusion were independent predictors of post-ASCT higher deep hematological response. The median follow-up was 8.6 years, and 38% of patients died. Independent predictors of superior overall survival in multivariate Cox regression analysis included full-dose melphalan, having no rest day, and infused CD34+ cells ≥ 4.5 × 106/kg. Independent predictors of higher day-100 transplant-related mortality (TRM) in nominal logistic regression analysis included poorer performance status, NT-proBNP/BNP ≥ 1800/400 pg/mL, serum albumin < 2.5 g/dL, CD34+ cells < 4.5 × 106/kg, and not having a rest day. In conclusion, 1 day of melphalan conditioning and administration of CD34+ cells ≥ 4.5 × 106/kg are recommended for ASCT in AL amyloidosis.
Item Description:Im Text ist "+" hochgestellt
Gesehen am 10.10.2025
Physical Description:Online Resource
ISSN:1096-8652
DOI:10.1002/ajh.27685

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