PREVALENCE AND PROGNOSTIC IMPACT OF OLIGOCLONAL BANDS IN PATIENTS WITH AL AMYLOIDOSIS
(Abstract release date: 05/19/16)
EHA Library. Rodríguez-Lobato L. 06/09/16; 132856; E1307
Dr. Luis Gerardo Rodríguez-Lobato
Contributions
Contributions
Abstract
Abstract: E1307
Type: Eposter Presentation
Background
The emergence of oligoclonal bands (OB) in patients with multiple myeloma (MM) achieving a complete response (CR) is a well-recognized event after autologous stem-cell transplantation (ASCT) and the use of novel agents. The presence of OB is considered a benign phenomenon, associated with favorable outcome due to a deeper humoral immune reconstitution. However, the frequency of clinical impact and outcomes of the emergence OB in patients with AL amyloidosis have never been described.
Aims
The objective of this study is to determine the prevalence, natural history and prognostic impact of OB in patients with AL amyloidosis who achieved at least a partial response (PR) either after upfront ASCT or after conventional treatment in patients ineligible for transplant at Hospital Clínic of Barcelona.
Methods
We reviewed the clinical records of patients with AL amyloidosis from January 1996 to September 2015. Fifty-six patients (27F/29M; median age at diagnosis 59 years; range 39 to 82) with PR or better after different induction regimens and/or ASCT were found. Initial baseline demographics, clinical and laboratory data, treatment and follow-up were collected. Median follow-up was 3.6 years. An OB was defined by the presence of a serum and/or urine immunofixation monoclonal spike different either in heavy and/or light chain component from the original amyloid protein.
Results
Fifty-three percent (30) of the patients were transplant ineligible while 46.4% (26) that had received an ASCT. The distribution of the immunoglobulin isotypes at diagnosis was as follows: light chains only (53.6%), IgG (35.7%), IgA (5.4%), IgM (3.6%), and one patient biclonal (1.8%). The light chain type was lambda in 43 patients (76.8%). Response achieved was: CR in 50% of patients, very good partial response (VGPR) 48.2% and PR in one patient. Three-year survival rate was 84%.We observed OB in 59% of the patients. The median number of bands per patient was 2 (range 1 to 5). The most frequents isotypes were IgG-kappa (31%) and IgG-lambda (22%). The oligoclonal phenomenon was more prevalent in patients in CR compared to the other degrees of response (82.1% vs. 35.7%; p=0.0001). There were no statistical differences between the emergence of OB and type of treatment received (50% chemotherapy alone vs. 69.2% ASCT; p=0.145) or isotype of involved light chains (46.2% for kappa vs. 62.8% for lambda; p=0.29). However, the presence of OB was more frequent in the group of patients who received induction chemotherapy (mainly bortezomib-based; 75%) before ASCT as compared to those who received upfront ASCT (91.7% vs. 50%; p=0.02). Duration of oligoclonality for more than one year was more prevalent in patients who underwent ASCT than in those ineligible for transplant (42.3% vs. 16.7%; p=0.034). Regarding its prognostic value, the presence of oligoclonality lasting for more than one year resulted in a significantly longer overall survival (OS) as compared to patients without OB or with only a transient phenomena (p=0.012), (Figure 1).
Conclusion
This is the first report describing the prevalence of OB in patients with AL amyloidosis after first-line therapy, which is even higher than that observed in patients with MM. The oligoclonal humoral phenomenon was more prevalent in patients who achieved CR as well as in those who received induction therapy prior to ASCT. Patients with oligoclonal humoral response lasting for more than one year had a significantly longer OS than those with shorter duration, likely reflecting a more robust humoral immune response.
Session topic: E-poster
Keyword(s): AL amyloidosis, Complete remission, Prognosis
Type: Eposter Presentation
Background
The emergence of oligoclonal bands (OB) in patients with multiple myeloma (MM) achieving a complete response (CR) is a well-recognized event after autologous stem-cell transplantation (ASCT) and the use of novel agents. The presence of OB is considered a benign phenomenon, associated with favorable outcome due to a deeper humoral immune reconstitution. However, the frequency of clinical impact and outcomes of the emergence OB in patients with AL amyloidosis have never been described.
Aims
The objective of this study is to determine the prevalence, natural history and prognostic impact of OB in patients with AL amyloidosis who achieved at least a partial response (PR) either after upfront ASCT or after conventional treatment in patients ineligible for transplant at Hospital Clínic of Barcelona.
Methods
We reviewed the clinical records of patients with AL amyloidosis from January 1996 to September 2015. Fifty-six patients (27F/29M; median age at diagnosis 59 years; range 39 to 82) with PR or better after different induction regimens and/or ASCT were found. Initial baseline demographics, clinical and laboratory data, treatment and follow-up were collected. Median follow-up was 3.6 years. An OB was defined by the presence of a serum and/or urine immunofixation monoclonal spike different either in heavy and/or light chain component from the original amyloid protein.
Results
Fifty-three percent (30) of the patients were transplant ineligible while 46.4% (26) that had received an ASCT. The distribution of the immunoglobulin isotypes at diagnosis was as follows: light chains only (53.6%), IgG (35.7%), IgA (5.4%), IgM (3.6%), and one patient biclonal (1.8%). The light chain type was lambda in 43 patients (76.8%). Response achieved was: CR in 50% of patients, very good partial response (VGPR) 48.2% and PR in one patient. Three-year survival rate was 84%.We observed OB in 59% of the patients. The median number of bands per patient was 2 (range 1 to 5). The most frequents isotypes were IgG-kappa (31%) and IgG-lambda (22%). The oligoclonal phenomenon was more prevalent in patients in CR compared to the other degrees of response (82.1% vs. 35.7%; p=0.0001). There were no statistical differences between the emergence of OB and type of treatment received (50% chemotherapy alone vs. 69.2% ASCT; p=0.145) or isotype of involved light chains (46.2% for kappa vs. 62.8% for lambda; p=0.29). However, the presence of OB was more frequent in the group of patients who received induction chemotherapy (mainly bortezomib-based; 75%) before ASCT as compared to those who received upfront ASCT (91.7% vs. 50%; p=0.02). Duration of oligoclonality for more than one year was more prevalent in patients who underwent ASCT than in those ineligible for transplant (42.3% vs. 16.7%; p=0.034). Regarding its prognostic value, the presence of oligoclonality lasting for more than one year resulted in a significantly longer overall survival (OS) as compared to patients without OB or with only a transient phenomena (p=0.012), (Figure 1).
Conclusion
This is the first report describing the prevalence of OB in patients with AL amyloidosis after first-line therapy, which is even higher than that observed in patients with MM. The oligoclonal humoral phenomenon was more prevalent in patients who achieved CR as well as in those who received induction therapy prior to ASCT. Patients with oligoclonal humoral response lasting for more than one year had a significantly longer OS than those with shorter duration, likely reflecting a more robust humoral immune response.
Session topic: E-poster
Keyword(s): AL amyloidosis, Complete remission, Prognosis
Abstract: E1307
Type: Eposter Presentation
Background
The emergence of oligoclonal bands (OB) in patients with multiple myeloma (MM) achieving a complete response (CR) is a well-recognized event after autologous stem-cell transplantation (ASCT) and the use of novel agents. The presence of OB is considered a benign phenomenon, associated with favorable outcome due to a deeper humoral immune reconstitution. However, the frequency of clinical impact and outcomes of the emergence OB in patients with AL amyloidosis have never been described.
Aims
The objective of this study is to determine the prevalence, natural history and prognostic impact of OB in patients with AL amyloidosis who achieved at least a partial response (PR) either after upfront ASCT or after conventional treatment in patients ineligible for transplant at Hospital Clínic of Barcelona.
Methods
We reviewed the clinical records of patients with AL amyloidosis from January 1996 to September 2015. Fifty-six patients (27F/29M; median age at diagnosis 59 years; range 39 to 82) with PR or better after different induction regimens and/or ASCT were found. Initial baseline demographics, clinical and laboratory data, treatment and follow-up were collected. Median follow-up was 3.6 years. An OB was defined by the presence of a serum and/or urine immunofixation monoclonal spike different either in heavy and/or light chain component from the original amyloid protein.
Results
Fifty-three percent (30) of the patients were transplant ineligible while 46.4% (26) that had received an ASCT. The distribution of the immunoglobulin isotypes at diagnosis was as follows: light chains only (53.6%), IgG (35.7%), IgA (5.4%), IgM (3.6%), and one patient biclonal (1.8%). The light chain type was lambda in 43 patients (76.8%). Response achieved was: CR in 50% of patients, very good partial response (VGPR) 48.2% and PR in one patient. Three-year survival rate was 84%.We observed OB in 59% of the patients. The median number of bands per patient was 2 (range 1 to 5). The most frequents isotypes were IgG-kappa (31%) and IgG-lambda (22%). The oligoclonal phenomenon was more prevalent in patients in CR compared to the other degrees of response (82.1% vs. 35.7%; p=0.0001). There were no statistical differences between the emergence of OB and type of treatment received (50% chemotherapy alone vs. 69.2% ASCT; p=0.145) or isotype of involved light chains (46.2% for kappa vs. 62.8% for lambda; p=0.29). However, the presence of OB was more frequent in the group of patients who received induction chemotherapy (mainly bortezomib-based; 75%) before ASCT as compared to those who received upfront ASCT (91.7% vs. 50%; p=0.02). Duration of oligoclonality for more than one year was more prevalent in patients who underwent ASCT than in those ineligible for transplant (42.3% vs. 16.7%; p=0.034). Regarding its prognostic value, the presence of oligoclonality lasting for more than one year resulted in a significantly longer overall survival (OS) as compared to patients without OB or with only a transient phenomena (p=0.012), (Figure 1).
Conclusion
This is the first report describing the prevalence of OB in patients with AL amyloidosis after first-line therapy, which is even higher than that observed in patients with MM. The oligoclonal humoral phenomenon was more prevalent in patients who achieved CR as well as in those who received induction therapy prior to ASCT. Patients with oligoclonal humoral response lasting for more than one year had a significantly longer OS than those with shorter duration, likely reflecting a more robust humoral immune response.
Session topic: E-poster
Keyword(s): AL amyloidosis, Complete remission, Prognosis
Type: Eposter Presentation
Background
The emergence of oligoclonal bands (OB) in patients with multiple myeloma (MM) achieving a complete response (CR) is a well-recognized event after autologous stem-cell transplantation (ASCT) and the use of novel agents. The presence of OB is considered a benign phenomenon, associated with favorable outcome due to a deeper humoral immune reconstitution. However, the frequency of clinical impact and outcomes of the emergence OB in patients with AL amyloidosis have never been described.
Aims
The objective of this study is to determine the prevalence, natural history and prognostic impact of OB in patients with AL amyloidosis who achieved at least a partial response (PR) either after upfront ASCT or after conventional treatment in patients ineligible for transplant at Hospital Clínic of Barcelona.
Methods
We reviewed the clinical records of patients with AL amyloidosis from January 1996 to September 2015. Fifty-six patients (27F/29M; median age at diagnosis 59 years; range 39 to 82) with PR or better after different induction regimens and/or ASCT were found. Initial baseline demographics, clinical and laboratory data, treatment and follow-up were collected. Median follow-up was 3.6 years. An OB was defined by the presence of a serum and/or urine immunofixation monoclonal spike different either in heavy and/or light chain component from the original amyloid protein.
Results
Fifty-three percent (30) of the patients were transplant ineligible while 46.4% (26) that had received an ASCT. The distribution of the immunoglobulin isotypes at diagnosis was as follows: light chains only (53.6%), IgG (35.7%), IgA (5.4%), IgM (3.6%), and one patient biclonal (1.8%). The light chain type was lambda in 43 patients (76.8%). Response achieved was: CR in 50% of patients, very good partial response (VGPR) 48.2% and PR in one patient. Three-year survival rate was 84%.We observed OB in 59% of the patients. The median number of bands per patient was 2 (range 1 to 5). The most frequents isotypes were IgG-kappa (31%) and IgG-lambda (22%). The oligoclonal phenomenon was more prevalent in patients in CR compared to the other degrees of response (82.1% vs. 35.7%; p=0.0001). There were no statistical differences between the emergence of OB and type of treatment received (50% chemotherapy alone vs. 69.2% ASCT; p=0.145) or isotype of involved light chains (46.2% for kappa vs. 62.8% for lambda; p=0.29). However, the presence of OB was more frequent in the group of patients who received induction chemotherapy (mainly bortezomib-based; 75%) before ASCT as compared to those who received upfront ASCT (91.7% vs. 50%; p=0.02). Duration of oligoclonality for more than one year was more prevalent in patients who underwent ASCT than in those ineligible for transplant (42.3% vs. 16.7%; p=0.034). Regarding its prognostic value, the presence of oligoclonality lasting for more than one year resulted in a significantly longer overall survival (OS) as compared to patients without OB or with only a transient phenomena (p=0.012), (Figure 1).
Conclusion
This is the first report describing the prevalence of OB in patients with AL amyloidosis after first-line therapy, which is even higher than that observed in patients with MM. The oligoclonal humoral phenomenon was more prevalent in patients who achieved CR as well as in those who received induction therapy prior to ASCT. Patients with oligoclonal humoral response lasting for more than one year had a significantly longer OS than those with shorter duration, likely reflecting a more robust humoral immune response.
Session topic: E-poster
Keyword(s): AL amyloidosis, Complete remission, Prognosis
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