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Kidney Week

Abstract: PO2182

Renal Outcomes After Autologous Stem Cell Transplant for AL Amyloidosis

Session Information

  • Onco-Nephrology - 1
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Bumma, Naresh, The Ohio State University, Columbus, Ohio, United States
  • Ozga, Michael, The Ohio State University, Columbus, Ohio, United States
  • Ayoub, Isabelle, The Ohio State University, Columbus, Ohio, United States
  • Almaani, Salem, The Ohio State University, Columbus, Ohio, United States
  • Sharma, Nidhi, The Ohio State University, Columbus, Ohio, United States
  • Efebera, Yvonne A., The Ohio State University, Columbus, Ohio, United States
  • Parikh, Samir V., The Ohio State University, Columbus, Ohio, United States
Background

Renal involvement in AL Amyloidosis is common and results in end-stage kidney disease (ESKD) in 30% of cases within 3 years of diagnosis. Newer therapeutic regimens directed at the plasma cell clone including high-dose melphalan with autologous stem cell transplantation (ASCT) are associated with improved survival but effect on renal outcome is not well established. We evaluated renal outcomes for patients who underwent ASCT and achieved a complete (CR) or very good partial (VGPR) hematologic response.

Methods

We performed a retrospective analysis of 50 AL Amyloidosis patients who underwent ASCT. Patients with renal involvement who achieved a hematologic response were included. Renal response was defined prior to transplant, according to consensus guidelines, as partial response (PR, > 30% decrease in proteinuria) or stable disease (SD, ≤ 30% proteinuria reduction). Primary endpoints were progression free survival (PFS) and overall survival (OS). PFS and OS were defined as the time from transplant to day of progression or death, respectively. Kaplan-Meier survival function estimated the PFS and OS. The log-rank test tested the equality of survivor functions between different groups of patients

Results

Following ASCT, 16 patients (32%) achieved hematological VPGR/CR after ASCT. All had renal involvement. Baseline and 1-year post-transplant proteinuria and serum creatinine (SCr) levels are shown in the Table. In the group of pts achieving VGPR/CR as hematological response PFS and OS were similar for patients having PR and SD as renal response (p=0.89 and p=0.44, respectively). No patients required hemodialysis. Median follow up for PFS was 4.1 years and for OS was 5.6 years (PR) and 11.9 years (SD).

Conclusion

Hematological response is important in AL amyloidosis and survival improves similarly with VGFR and CR. In patients with renal involvement, this study shows similar outcomes to patients who achieved a PR or SD as renal response prior to ASCT. However, our study has a small sample size and we would recommend a larger study.

RENAL RESPONSE METRICS PRE AND POST ASCT
 Partial Response (n=6)Stable Disease (n=10)
AT DIAGNOSISMedian 24hr Proteinuria g/d (range)8.0 (1.9-11.3)7.2 (2.0-15.0)
Median SCr mg/dl (range)3.0 (0.8-4.2)1.3 (0.7- 4.8)
1 YR POST TRANSPLANTMedian 24hr Proteinuria mg/d (range)2.5 (0.7-2.5)2.2 (1.5-4.9)
Median SCr mg/dl (range)1.7 ( 0.5-3.1)1.6 ( 0.6- 3.6)

Median serum Creatinine prior to ASCT in PR group was 1.2 mg/dl and 2.0 mg/dl in SD group.