Department of Medical Oncology, University Hospital and University of Berne, Switzerland;
Swiss Med Wkly. 2014 Feb 19;144:w13922. doi: 10.4414/smw.2014.13922.
High-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) has been reported to confer better prognosis in systemic light chain AL-amyloidosis as compared with conventional chemotherapy. However, only limited data are available so far on treatment and outcome of AL-amyloidosis patients in Switzerland.
Within a single-centre cohort of patients with biopsy confirmed AL-amyloidosis diagnosed between January 1995 and December 2012, we aimed to investigate treatment effects in patients treated with conventional chemotherapy versus HDCT with ASCT.
We identified 50 patients with AL-amyloidosis treated with conventional chemotherapy and 13 patients who received HDCT with ASCT. Clinical characteristics differed between the groups for the age of the patients (59 years for patients with ASCT/HDCT vs 69 years; p= 0.0006) and the troponin-T value (0.015 μg/l vs 0.08 μg/l; p = 0.0279). Patients with ASCT showed a trend towards better overall survival, with median survival not yet reached compared with 53 months in patients on conventional chemotherapy (p = 0.0651).
Our results suggest that light chain AL-amyloidosis patients considered fit to undergo HDCT and ASCT may have a better outcome than patients treated exclusively with conventional chemotherapy regimens; however, the better performance status of patients receiving HDCT may have added to this treatment effect.
与常规化疗相比，大剂量化疗（HDCT）联合自体干细胞移植（ASCT）已被报道可改善系统性轻链 AL 淀粉样变性的预后。然而，迄今为止，瑞士关于 AL 淀粉样变性患者治疗和结局的数据有限。
在 1995 年 1 月至 2012 年 12 月间确诊的经活检证实的 AL 淀粉样变性患者的单中心队列中，我们旨在调查接受常规化疗与 HDCT+ASCT 治疗的患者的治疗效果。
我们确定了 50 例接受常规化疗的 AL 淀粉样变性患者和 13 例接受 HDCT+ASCT 的患者。两组患者的临床特征存在差异，年龄（ASCT/HDCT 组为 59 岁，常规化疗组为 69 岁；p=0.0006）和肌钙蛋白 T 值（0.015μg/l 与 0.08μg/l；p=0.0279）。接受 ASCT 的患者总体生存情况有改善的趋势，中位生存时间尚未达到，而接受常规化疗的患者为 53 个月（p=0.0651）。
我们的结果表明，适合接受 HDCT+ASCT 的轻链 AL 淀粉样变性患者的结局可能优于仅接受常规化疗方案治疗的患者；然而，接受 HDCT 的患者的更好表现状态可能对该治疗效果有一定影响。
