Fluid Retention and Weight Gain During Peripheral Blood Hematopoietic Stem Cell Mobilization in Light Chain Amyloidosis

Fluid Retention And Weight Gain During Peripheral Blood Hematopoietic Stem Cell Mobilization In Light Chain Amyloidosis.

Background: High-dose chemotherapy and autologous hematopoietic stem cell transplantation (auto-HCT) is an effective treatment for systemic light chain amyloidosis (AL).  Fluid retention and weight gain during peripheral blood hematopoietic stem cell (PBSC) mobilization with growth factors like filgrastim is a predictor of poor outcome after auto-HCT for AL.¹ 

Methods: We performed a retrospective chart review to identify patients with excessive weight gain while undergoing filgrastim-induced PBSC mobilization.  The primary endpoint was to determine the incidence of > 2% body weight gain during PBSC mobilization. Secondary endpoints were to identify the factors that predict abnormal weight gain and to evaluate its impact on NRM and OS after auto-HCT.

Results: We identified 95 patients with AL who underwent PBSC mobilization and collection followed by auto-HCT between 2002 and 2011. Thirty-nine (41%) patients had renal involvement, 12 patients had cardiac involvement (12.6%) and 5 (5.2%) patients had liver involvement. Seven patients required hospitalization during PBSC mobilization due to fluid overload.  Six patients died within a year of auto-HCT non-relapse causes with 1-year NRM of 6.3%. Median follow up after auto-HCT in surviving patients was 13 months. Kaplan-Meier estimates of median OS was 73 months. Forty-nine (51.5%) patients had >2% weight gain due to fluid overload during PBSC mobilization, while 46 patients (48.5%) had ≤2 % weight gain. More patients with >2% weight gain required diuretics (34 vs. 10: p <0.0001) and had lower median serum albumin (2.8 vs. 3.75 g/dl, p<0.0001).  There were no significant differences in baseline serum creatinine, GFR, alkaline phosphatase, filgrastim dose, urine total protein, BNP, ejection fraction, cardiac septal thickness, number of organs involved, or cardiac or renal involvement between the two groups.  1-year NRM was 6.1 vs. 8.6 % in patients with >2% or ≤2% weight gain (p=0.70). There was no significant difference in median OS survival between patients with > or ≤2% weight gain (p=0.54: Figure).

Conclusion: Patients with AL and low baseline serum albumin are at higher risk of fluid retention and excessive weight gain that may require hospitalization. However, in our study, this weight gain did not have an adverse impact on NRM or OS.

¹Leung N et al. Blood 2005;106:3353-3357