High Dose Melphalan and Autologous Stem Cell Transplantation for Systemic AL Amyloidosis –Single Institute Analysis of 35 Cases–

We report 35 patients who received high dose melphalan and autologous stem cell transplantation for systemic AL amyloidosis. Between Sep. 2006 and Jul. 2012, 35 patients with AL amyloidosis were transplanted at Japanese Red Cross Medical Center. Characteristics of patients were shown as follows: median age; 54 (range 39-70), M/F=15/20, major organ involvement; heart 13, kidney 19, others 3 (liver 1, trachea 1, peripheral nerve 1), median melphalan dose; 128 (range 50-200) mg/m², median infused CD34+ cells; 2.67 (range 1.17-11.26) x 10⁶/kg. Out of 35 patients, 28 are alive after median follow up of 18.7 (range 2-68) months and two and four years estimated overall survival were 84.6% and 66.6%, respectively. Four patients died of heart failure and other three patients died of either gastrointestinal bleeding, bacteremia, or malignancy. Four year estimated survival of patients with cardiac involvement is 46.2% and is significantly lower as compared with that with others (69.2%). Serum albumin increased (average 21%) in patients survived more than 12 months after ASCT. Serum free light chain (FLC) was measured before and after ASCT in 7 patients, and of those, FLC rapidly decreased after ASCT in 5 patients. Patients without cardiac involvement showed satisfactory survival with improvement of clinical symptom and serum albumin. Careful patient selection and experienced management are important especially for patients with cardiac involvement. Serum FLC may be useful for evaluating effectiveness of ASCT and also for early detection of relapse.