TY - JOUR
T1 - Delayed autologous stem cell transplantation following cardiac transplantation experience in patients with cardiac amyloidosis
AU - Trachtenberg, Barry H.
AU - Kamble, Rammurti T.
AU - Rice, Lawrence
AU - Araujo-Gutierrez, Raquel
AU - Bhimaraj, Arvind
AU - Guha, Ashrith
AU - Park, Myung H.
AU - Hussain, Imad
AU - Bruckner, Brian A.
AU - Suarez, Erik E.
AU - Victor, III, David W.
AU - Adrogue, Horacio E.
AU - Baker, Kelty R.
AU - Estep, Jerry D.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - This study sought to retrospectively investigate the outcomes of patients with light-chain amyloidosis (AL) with advanced cardiac involvement who were treated with a strategy of heart transplantation (HT) followed by delayed autologous stem cell transplantation (ASCT) at 1-year posttransplant. Patients with AL amyloidosis with substantial cardiac involvement have traditionally had very poor survival (eg, several months). A few select centers have reported their outcomes for HT followed by a strategy of early ASCT (ie, 6 months) for CA. The outcomes of patients undergoing a delayed strategy have not been reported. All patients with AL amyloidosis at a single institution undergoing evaluation for HT from 2004-2018 were included. Retrospective analyses were performed. Sixteen patients underwent HT (including two combined heart-kidney transplant) for AL amyloidosis. ASCT was performed in a total of nine patients to date at a median 13.5 months (12.8-32.9 months) post-HT. Survival was 87.5% at 1 year and 76.6% at 5 years, comparable to institutional outcomes for nonamyloid HT recipients. In addition to these 16 patients, two patients underwent combined heart-lung transplantation. A strategy of delayed ASCT 1-year post-HT for patients with AL amyloidosis is feasible, safe, and associated with comparable outcomes to those undergoing an earlier ASCT strategy.
AB - This study sought to retrospectively investigate the outcomes of patients with light-chain amyloidosis (AL) with advanced cardiac involvement who were treated with a strategy of heart transplantation (HT) followed by delayed autologous stem cell transplantation (ASCT) at 1-year posttransplant. Patients with AL amyloidosis with substantial cardiac involvement have traditionally had very poor survival (eg, several months). A few select centers have reported their outcomes for HT followed by a strategy of early ASCT (ie, 6 months) for CA. The outcomes of patients undergoing a delayed strategy have not been reported. All patients with AL amyloidosis at a single institution undergoing evaluation for HT from 2004-2018 were included. Retrospective analyses were performed. Sixteen patients underwent HT (including two combined heart-kidney transplant) for AL amyloidosis. ASCT was performed in a total of nine patients to date at a median 13.5 months (12.8-32.9 months) post-HT. Survival was 87.5% at 1 year and 76.6% at 5 years, comparable to institutional outcomes for nonamyloid HT recipients. In addition to these 16 patients, two patients underwent combined heart-lung transplantation. A strategy of delayed ASCT 1-year post-HT for patients with AL amyloidosis is feasible, safe, and associated with comparable outcomes to those undergoing an earlier ASCT strategy.
KW - autotransplantation
KW - bone marrow/hematopoietic stem cell transplantation
KW - cardiovascular disease
KW - clinical research/practice
KW - heart failure/injury
KW - heart transplantation/cardiology
KW - stem cells
UR - http://www.scopus.com/inward/record.url?scp=85068425606&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068425606&partnerID=8YFLogxK
U2 - 10.1111/ajt.15487
DO - 10.1111/ajt.15487
M3 - Article
C2 - 31152491
AN - SCOPUS:85068425606
VL - 19
SP - 2900
EP - 2909
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 10
ER -