Haematologica, Vol 92, Issue 10, 1351-1358 doi:10.3324/haematol.11325
Copyright © 2007 by Ferrata Storti Foundation
Efstathios Kastritis ,
Athanasios Anagnostopoulos ,
Maria Roussou ,
Savvas Toumanidis ,
Constantinos Pamboukas ,
Magdalini Migkou ,
Anna Tassidou ,
Irini Xilouri ,
Sossana Delibasi ,
Erasmia Psimenou ,
Sofia Mellou ,
Evangelos Terpos ,
John Nanas ,
Meletios A. Dimopoulos
Copyright © 2007 by Ferrata Storti Foundation
Amyloidosis |
Treatment of light chain (AL) amyloidosis with the combination of bortezomib and dexamethasone
From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece (EK, AA, MR, ST, CP, MM, EP, JN, MAD); Department of Hemopathology, Evangelismos Hospital, Athens, Greece (AT); Department of Hematology, University Hospital of Heraklion, Crete, Greece (IX); Department of Hematology, Evangelismos Hospital, Athens, Greece (SD); Henry Dynan Hospital, Athens, Greece (SM); General Airforce Hospital, Athens, Greece (ET)
Correspondence: Meletios A. Dimopoulos, M.D., 227 Kifissias Avenue, Kifissia, Athens 14561, Greece. E-mail: mdimop{at}med.uoa.gr
Background and Objectives: High-dose melphalan and autologous stem cell transplantation is currently the treatment of choice for selected patients with AL amyloidosis; however, new treatments are needed for patients who are ineligible for or relapse after this procedure. Bortezomib is a proteasome inhibitor with proven activity in multiple myeloma, and the addition of dexamethasone results in superior outcome. We evaluated the activity and feasibility of the combination of bortezomib and dexamethasone (BD) in patients with AL amyloidosis.
Design and Methods: Consecutive patients with histologically proven, symptomatic AL amyloidosis were treated with BD.
Results: Eighteen patients, including seven who had relapsed or progressed after previous therapies were treated with BD. Eleven (61%) patients had two or more organs involved; kidneys and heart were affected in 14 and 15 patients, respectively. The majority of patients had impaired performance status and high brain natriuretic peptide values; serum creatinine was elevated in six patients. Among evaluable patients, 94% had a hematologic response and 44% a hematologic complete response, including all five patients who had not responded to prior high dose dexamethasone-based treatment and one patient under dialysis. Five patients (28%) had a response in at least one affected organ. Hematologic responses were rapid (median 0.9 months) and median time to organ response was 4 months. Neurotoxicity, fatigue, peripheral edema, constipation and exacerbation of postural hypotension were manageable although necessitated dose adjustment or treatment discontinuation in 11 patients.
Interpretation and Conclusions: The combination of BD is feasible in patients with AL amyloidosis. Patients achieve a rapid hematologic response and toxicity can be managed with close follow-up and appropriate dose adjustment. This treatment may be a valid option for patients with severe heart or kidney impairment.
Key words: primary amyloidosis, bortezomib, BNP, renal failure.
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