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Abstract: SA-PO123

Multicenter Study of Renal Outcomes in AL Amyloidosis Patients After Autologous Stem Cell Transplant

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Selamet, Umut, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Joachim, Kole, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Lin, Yan Heather, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Motwani, Shveta S., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Page, Valda D., The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Murakami, Naoka, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Abudayyeh, Ala, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Background

Renal impairment is a common complication with negative impact on survival in AL amyloidosis patients. Autologous stem cell transplant (ASCT) is standard of care for treatment of AL amyloidosis, but data on renal outcomes after ASCT are lacking. We aimed to analyze longitudinal trends in kidney function and its impact on progression-free (PFS) and overall survival (OS) post ASCT in AL amyloidosis patients.

Methods

We performed a retrospective review of 314 patients with AL amyloidosis who underwent ASCT at MD Anderson Cancer Center and Dana Farber Cancer Center from 2010 to 2020. We collected data on demographics, comorbidities, ISS stage, disease status at time of ASCT, eGFR (CKD EPI), and laboratory variables at day 0, day 100, 6-months, years 1, 2 and 3 post ASCT. We evaluated the change in eGFR over time using linear mixed effect models. The association between eGFR change and PFS and OS were evaluated using the Cox proportional hazards models.

Results

A higher ISS stage at diagnosis was significantly associated with a lower GFR (p =0.0042). Black and Hispanic races were associated with lower eGFR across all time points (p ≤ .006). Higher serum light chains were associated with lower eGFR across all time points (decrease by 0.059-fold per 1 fold increase, p < 0.0001). There was no significant decline in eGFR over time. A higher eGFR at the time of ASCT (>median) was significantly associated with a longer PFS at baseline (HR (95% CI) = 1.610 (1.102, 2.354), p = 0.0139) and at 2 years post ASCT (HR (95% CI) = 2.351 (1.041, 5.308), p = 0.0396). A higher eGFR at baseline (HR (95% CI) = 1.676 (1.054, 2.663), p = 0.029) and at 6 months post ASCT (HR (95% CI) = 3.218 (1.709, 6.057), p = 0.0003) was associated with better OS. A good disease risk category, lack of kidney amyloid, lower light chains, lower ISS score, were all associated with a higher PFS and OS at different time points. Higher hemoglobin and albumin were also associated with longer PFS.

Conclusion

This study provides valuable data on renal outcomes in patients with AL amyloidosis who underwent ASCT. Disease related factors were the main predictors of eGFR, however no significant decline in eGFR observed in AL amyloidosis patients after ASCT. Higher eGFR was associated with better PFS and OS at baseline and at year 2 post ASCT.