From CyBorD to dara-CyBorD, ASCT utilization trends in AL amyloidosis: a 15-year analysis
Abstract: This retrospective analysis examined 15 years of autologous stem cell transplantation (ASCT) for light chain (AL) amyloidosis at the Mayo Clinic (2010-2024). We aimed to assess ASCT utilization trends, factors influencing practice changes, and current indications amid newer therapies. Four...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-08-01
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| Series: | Blood Advances |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2473952925003672 |
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| author | Eli Muchtar Angela Dispenzieri Francis K. Buadi Prashant Kapoor David Dingli Taxiarchis V. Kourelis Wilson Gonsalves Nelson Leung Suzanne R. Hayman Martha Q. Lacy Mustaqeem Siddiqui Joselle Cook Nadine Abdallah Moritz Binder Saurabh Zanwar William Hogan Rahma Warsame S. Vincent Rajkumar Shaji K. Kumar Morie A. Gertz |
| author_facet | Eli Muchtar Angela Dispenzieri Francis K. Buadi Prashant Kapoor David Dingli Taxiarchis V. Kourelis Wilson Gonsalves Nelson Leung Suzanne R. Hayman Martha Q. Lacy Mustaqeem Siddiqui Joselle Cook Nadine Abdallah Moritz Binder Saurabh Zanwar William Hogan Rahma Warsame S. Vincent Rajkumar Shaji K. Kumar Morie A. Gertz |
| author_sort | Eli Muchtar |
| collection | DOAJ |
| description | Abstract: This retrospective analysis examined 15 years of autologous stem cell transplantation (ASCT) for light chain (AL) amyloidosis at the Mayo Clinic (2010-2024). We aimed to assess ASCT utilization trends, factors influencing practice changes, and current indications amid newer therapies. Four hundred and forty-one ASCTs were divided into cohort 1 (2010-2019) and cohort 2 (2020-2024), revealing a significant ASCT reduction in cohort 2 (385 vs 56, average 71% annual decrease). Cohort 2 patients were older, more likely to have relapsed/refractory disease, and had higher baseline bone marrow plasma cell burden compared to cohort 1. Pre-ASCT induction was more frequent in cohort 2 (89.3% vs 56.4%), with daratumumab (Dara)–cyclophosphamide-bortezomib-dexamethasone (CyBorD) replacing CyBorD as the predominant induction regimen. Lymphoma-based regimens were also more common in cohort 2 (15.1% vs 5.3%, P = .02). Day-100 satisfactory hematological response improved in cohort 2 (91.1% vs 72.7%, P = .001), although hematological complete response rates did not significantly differ (50.9% vs 38.8%, P = .09). In summary, there is a decrease in the utilization of ASCT in AL amyloidosis. This procedure is primarily reserved for patients with suboptimal responses, relapsed/refractory disease, lymphoplasmacytic clones (predominantly immunoglobulin M amyloidosis), or high bone marrow plasma cell burden (myeloma phenotype). This study underscores a significant shift in ASCT practice, driven by novel therapies, emphasizing more personalized management in AL amyloidosis. |
| format | Article |
| id | doaj-art-96eff48a39fa4444bfc1738c3deda5a3 |
| institution | Kabale University |
| issn | 2473-9529 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Blood Advances |
| spelling | doaj-art-96eff48a39fa4444bfc1738c3deda5a32025-08-20T05:07:22ZengElsevierBlood Advances2473-95292025-08-019164311431610.1182/bloodadvances.2025016586From CyBorD to dara-CyBorD, ASCT utilization trends in AL amyloidosis: a 15-year analysisEli Muchtar0Angela Dispenzieri1Francis K. Buadi2Prashant Kapoor3David Dingli4Taxiarchis V. Kourelis5Wilson Gonsalves6Nelson Leung7Suzanne R. Hayman8Martha Q. Lacy9Mustaqeem Siddiqui10Joselle Cook11Nadine Abdallah12Moritz Binder13Saurabh Zanwar14William Hogan15Rahma Warsame16S. Vincent Rajkumar17Shaji K. Kumar18Morie A. Gertz19Division of Hematology, Mayo Clinic, Rochester, MN; Correspondence: Eli Muchtar, Division of Hematology, Mayo Clinic, 200 First St, SW, Rochester, MN 55905;Division of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNDivision of Hematology, Mayo Clinic, Rochester, MNAbstract: This retrospective analysis examined 15 years of autologous stem cell transplantation (ASCT) for light chain (AL) amyloidosis at the Mayo Clinic (2010-2024). We aimed to assess ASCT utilization trends, factors influencing practice changes, and current indications amid newer therapies. Four hundred and forty-one ASCTs were divided into cohort 1 (2010-2019) and cohort 2 (2020-2024), revealing a significant ASCT reduction in cohort 2 (385 vs 56, average 71% annual decrease). Cohort 2 patients were older, more likely to have relapsed/refractory disease, and had higher baseline bone marrow plasma cell burden compared to cohort 1. Pre-ASCT induction was more frequent in cohort 2 (89.3% vs 56.4%), with daratumumab (Dara)–cyclophosphamide-bortezomib-dexamethasone (CyBorD) replacing CyBorD as the predominant induction regimen. Lymphoma-based regimens were also more common in cohort 2 (15.1% vs 5.3%, P = .02). Day-100 satisfactory hematological response improved in cohort 2 (91.1% vs 72.7%, P = .001), although hematological complete response rates did not significantly differ (50.9% vs 38.8%, P = .09). In summary, there is a decrease in the utilization of ASCT in AL amyloidosis. This procedure is primarily reserved for patients with suboptimal responses, relapsed/refractory disease, lymphoplasmacytic clones (predominantly immunoglobulin M amyloidosis), or high bone marrow plasma cell burden (myeloma phenotype). This study underscores a significant shift in ASCT practice, driven by novel therapies, emphasizing more personalized management in AL amyloidosis.http://www.sciencedirect.com/science/article/pii/S2473952925003672 |
| spellingShingle | Eli Muchtar Angela Dispenzieri Francis K. Buadi Prashant Kapoor David Dingli Taxiarchis V. Kourelis Wilson Gonsalves Nelson Leung Suzanne R. Hayman Martha Q. Lacy Mustaqeem Siddiqui Joselle Cook Nadine Abdallah Moritz Binder Saurabh Zanwar William Hogan Rahma Warsame S. Vincent Rajkumar Shaji K. Kumar Morie A. Gertz From CyBorD to dara-CyBorD, ASCT utilization trends in AL amyloidosis: a 15-year analysis Blood Advances |
| title | From CyBorD to dara-CyBorD, ASCT utilization trends in AL amyloidosis: a 15-year analysis |
| title_full | From CyBorD to dara-CyBorD, ASCT utilization trends in AL amyloidosis: a 15-year analysis |
| title_fullStr | From CyBorD to dara-CyBorD, ASCT utilization trends in AL amyloidosis: a 15-year analysis |
| title_full_unstemmed | From CyBorD to dara-CyBorD, ASCT utilization trends in AL amyloidosis: a 15-year analysis |
| title_short | From CyBorD to dara-CyBorD, ASCT utilization trends in AL amyloidosis: a 15-year analysis |
| title_sort | from cybord to dara cybord asct utilization trends in al amyloidosis a 15 year analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2473952925003672 |
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