Cardiac transplantation followed by dose-intensive melphalan and autologous stem-cell transplantation for light chain amyloidosis and heart failure

Bimalangshu R. Dey, Stephen S. Chung, Thomas R. Spitzer, Hui Zheng, Thomas E. MacGillivray, David C. Seldin, Steven McAfee, Karen Ballen, Eyal Attar, Thomas Wang, Jordan Shin, Christopher Newton-Cheh, Stephanie Moore, Vaishali Sanchorawala, Martha Skinner, Joren C. Madsen, Marc J. Semigran

Research output: Contribution to journalArticlepeer-review

86 Scopus citations

Abstract

Background.: Patients with light chain (AL) amyloidosis who present with severe heart failure due to cardiac involvement rarely survive more than 6 months. Survival after cardiac transplantation is markedly reduced due to the progression of amyloidosis. Autologous stem-cell transplantation (ASCT) has become a common therapy for AL amyloidosis, but there is an exceedingly high treatment-related mortality in patients with heart failure. Methods.: We developed a treatment strategy of cardiac transplant followed by ASCT. Twenty-six patients were evaluated, and of 18 eligible patients, nine patients underwent cardiac transplantation. Eight of these patients subsequently received an ASCT. Results.: Six of seven evaluable patients achieved a complete hematologic remission, and one achieved a partial remission. At a median follow-up of 56 months from cardiac transplant, five of seven patients are alive without recurrent amyloidosis. Their survival is comparable with 17,389 patients who received heart transplants for nonamyloid heart disease: 64% in nonamyloid vs. 60% in amyloid patients at 7 years (P=0.83). Seven of eight transplanted patients have had no evidence of amyloid in their cardiac allograft. Conclusions.: This demonstrates that cardiac transplantation followed by ASCT is feasible in selected patients with AL amyloidosis and heart failure, and that such a strategy may lead to improved overall survival.

Original languageEnglish (US)
Pages (from-to)905-911
Number of pages7
JournalTransplantation
Volume90
Issue number8
DOIs
StatePublished - Oct 27 2010
Externally publishedYes

Keywords

  • Amyloid
  • Cardiac amyloidosis
  • Stem-cell transplantation

ASJC Scopus subject areas

  • Transplantation

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