Journal ArticleDOI
High-dose melphalan versus melphalan plus dexamethasone for AL amyloidosis.
Arnaud Jaccard,Philippe Moreau,Véronique Leblond,Xavier Leleu,Lofti Benboubker,Olivier Hermine,Christian Recher,Bouchra Asli,Bruno Lioure,Bruno Royer,Fabrice Jardin,Franck Bridoux,Bernard Grosbois,Jérôme Jaubert,Jean-Charles Piette,Pierre Ronco,Fabrice Quet,Michel Cogné,Jean-Paul Fermand +18 more
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TLDR
The outcome of treatment of AL amyloidosis with high-doseMelphalan plus autologous stem-cell rescue was not superior to the outcome with standard-dose melphalanplus dexamethasone.Abstract:
Background High-dose chemotherapy followed by autologous hematopoietic stem-cell transplantation has been reported to provide higher response rates and better overall survival than standard chemotherapy in immunoglobulin-light-chain (AL) amyloidosis, but these two strategies have not been compared in a randomized study. Methods We conducted a randomized trial comparing high-dose intravenous melphalan followed by autologous hematopoietic stem-cell rescue with standard-dose melphalan plus high-dose dexamethasone in patients with AL amyloidosis. Patients (age range, 18 to 70 years) with newly diagnosed AL amyloidosis were randomly assigned to receive intravenous high-dose melphalan plus autologous stem cells or oral melphalan plus oral high-dose dexamethasone. Results Fifty patients were enrolled in each group. The results were analyzed on an intention-to-treat basis, with overall survival as the primary end point. After a median follow-up of 3 years, the estimated median overall survival was 22.2 months in ...read more
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NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines
TL;DR: Lymphedema is a common complication after treatment for breast cancer and factors associated with increased risk of lymphedEMA include extent of axillary surgery, axillary radiation, infection, and patient obesity.
Journal ArticleDOI
Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association.
Biykem Bozkurt,Monica Colvin,Jennifer L. Cook,Leslie T. Cooper,Anita Deswal,Gregg C. Fonarow,Gary S. Francis,Daniel J. Lenihan,Eldrin F. Lewis,Dennis M. McNamara,Elfriede Pahl,Ramachandran S. Vasan,Kumudha Ramasubbu,Kismet Rasmusson,Jeffrey A. Towbin,Clyde W. Yancy +15 more
TL;DR: The intent of this American Heart Association (AHA) scientific statement is to summarize the current understanding of dilated cardiomyopathies, with special emphasis on recent developments in diagnostic approaches and therapies for specific cardiologyopathies.
Journal ArticleDOI
Monoclonal Gammopathy of Renal Significance: When MGUS Is No Longer Undetermined or Insignificant
Nelson Leung,Frank Bridoux,Colin A. Hutchison,Samih H. Nasr,Paul Cockwell,Jean Paul Fermand,Angela Dispenzieri,Kevin W. Song,Robert A. Kyle +8 more
TL;DR: The term monoclonal gammopathy of renal significance is thought to be most helpful to indicate a causal relationship between the monoconal gamsopathy and the renal damage and because the significance of the mon Coclonal Gammopathy is no longer undetermined.
Journal ArticleDOI
Amyloidosis: Pathogenesis and New Therapeutic Options
TL;DR: Treatment for AL amyloidosis is highly individualized, determined on the basis of age, organ dysfunction, and regimen toxicities, and should be guided by biomarkers of hematologic and cardiac response.
Journal ArticleDOI
A European collaborative study of treatment outcomes in 346 patients with cardiac stage III AL amyloidosis
Ashutosh D. Wechalekar,Stefan Schönland,Efstathios Kastritis,Julian D. Gillmore,Meletios A. Dimopoulos,Thirusha Lane,Andrea Foli,Darren Foard,Paolo Milani,Lisa Rannigan,Ute Hegenbart,Philip N. Hawkins,Giampaolo Merlini,Giovanni Palladini +13 more
TL;DR: Outcome and organ function of stage III AL amyloidosis without very elevated NT-proBNP and low SBP is improved by a very good hematologic response to chemotherapy, and an especially poor prognosis subgroup of patients with a median OS of only 3 months is identified.
References
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Journal ArticleDOI
Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): A consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis
Morie A. Gertz,Raymond L. Comenzo,Rodney H. Falk,Jean Paul Fermand,Bouke P. C. Hazenberg,Philip N. Hawkins,Giampaolo Merlini,Philippe Moreau,Pierre Ronco,Vaishali Sanchorawala,Orhan Sezer,Alan Solomon,Giles Grateau +12 more
TL;DR: A consensus panel was convened comprising 13 specialists actively involved in the treatment of patients with amyloidosis, and a consensus was developed defining each organ involved and the criteria for response.
Journal ArticleDOI
A Trial of Three Regimens for Primary Amyloidosis: Colchicine Alone, Melphalan and Prednisone, and Melphalan, Prednisone, and Colchicine
Robert A. Kyle,Morie A. Gertz,Philip R. Greipp,Thomas E. Witzig,John A. Lust,Martha Q. Lacy,Terry M. Therneau +6 more
TL;DR: Therapy with melphalan and prednisone results in objective responses and prolonged survival as compared with colchicine in patients with primary amyloidosis.
Journal ArticleDOI
Serum Reference Intervals and Diagnostic Ranges for Free κ and Free λ Immunoglobulin Light Chains: Relative Sensitivity for Detection of Monoclonal Light Chains
Jerry A. Katzmann,Raynell J. Clark,Roshini S. Abraham,Sandra C. Bryant,James F. Lymp,Arthur R. Bradwell,Robert A. Kyle +6 more
TL;DR: Reference and diagnostic intervals for serum FLCs have been developed for use with a new, automated immunoassay that makes the detection and quantification of monoclonal F LCs easier and more sensitive than with current methods.
Journal ArticleDOI
Tables of the number of patients required in clinical trials using the logrank test
TL;DR: The logrank test is commonly used in the analysis of clinical trials in chronic diseases such as cancer and the numbers required are considerably smaller than those in existing tables when the event-free proportions are small, but otherwise comparable.
Journal ArticleDOI
High-Dose Melphalan and Autologous Stem-Cell Transplantation in Patients with AL Amyloidosis: An 8-Year Study
Martha Skinner,Vaishali Sanchorawala,David C. Seldin,Laura M. Dember,Rodney H. Falk,John L. Berk,Jennifer J. Anderson,Carl O'Hara,Kathleen T. Finn,Caryn A. Libbey,Janice F. Wiesman,Karen Quillen,Niall Swan,Daniel G. Wright +13 more
TL;DR: Analysis of consecutive patients with AL amyloidosis from 6 separate trials over 8 years shows that high-dose intravenous melphalan therapy combined with autologous stem-cell transplantation greatly improves duration of survival and ameliorates organ dysfunction.