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Background: High-dose chemotherapy with autologous hematopoietic stem cell transplantation (auto-HCT) can be an effective treatment for systemic light chain amyloidosis (AL). However, significant morbidity may occur in AL patients undergoing peripheral blood stem cell (PBSC) mobilization, especially if they have cardiac or renal involvement. Reported complications include fluid overload, cardiac arrhythmias, bleeding events, and infections.
Methods: We identified 101 patients with AL who underwent PBSC mobilization and collection with filgrastim at a dose of 10 mcg/kg/day between 2006 and 2013. Fifteen patients (15%) also received plerixafor at a dose of 0.16-0.24 mg/kg/day after at least 4 days of filgrastim. The primary objective was to evaluate the incidence of adverse events (AE) during PBSC mobilization and collection. AE included weight gain greater than 2%, cardiac arrhythmias/events, hemorrhagic or thromboembolic events, failure to complete PBSC collection, and death.
Results: The median age of patients was 60 years and median serum creatinine was 1.09 mg/dL. Fifteen patients (15%) had cardiac involvement, 45 patients (45%) had renal involvement, and 21 patients (21%) had both cardiac and renal amyloid involvement. Ninety-two patients (91%) successfully collected a minimum of ≥ 2 x 106 CD34 cells/kg and proceeded to auto-HCT. Nine patients (9%) failed to complete initial PBSC mobilization attempt due to significant toxicity and 7 patients (7%) were never able to proceed to auto-HCT. Four patients (4%) died during the peri-mobilization period, with 3 deaths attributed to sepsis/multi-organ failure. Sixty-one patients (60%) developed weight gain > 2% of baseline weight. Seven patients (7%) experienced a cardiac event (5 atrial fibrillation/tachyarrhythmias, 1 myocardial infarction, and 1 hypertensive urgency). Five patients (5%) had a thromboembolic event (4 deep venous thromboses and 1 pulmonary embolism). Three patients (3%) developed a significant bleeding event (1 central nervous system and 2 gastrointestinal ). Because of high risk for complications during PBSC mobilization, 17 patients (17%) underwent PBSC mobilization as an inpatient. Furthermore, 14 patients (14%) began the mobilization process as an outpatient but were subsequently admitted for complications.
Conclusion: PBSC mobilization and collection is AL patients can be associated with significant morbidity, with almost 10% of patients unable to complete collection, and peri-mobilization mortality of almost 4%. Selected patients may benefit from hospitalization during PBSC mobilization and collection.