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The early dFLC level after autologous stem cell transplantation can predict the long-term prognosis of in patients with light chain amyloidosis
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DOI：10.1007/s00277-026-07238-z.png)
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Abstract
En 中文
Recent studies show that the post-treatment difference between involved and uninvolved light chains (dFLC) predicts long-term prognosis in light chain (AL) amyloidosis. However, this issue remains underexplored in patients treated with autologous stem cell transplantation (ASCT). We retrospectively reviewed 238 patients with AL amyloidosis who underwent ASCT between 2009 and 2024. Based on day 30 post-ASCT dFLC, patients were grouped as dFLC < 10 mg/L (n = 101) and dFLC ≥ 10 mg/L (n = 137). The dFLC < 10 mg/L group demonstrated significantly higher hematologic overall response rate (ORR) and complete response rate (100% vs. 73.0%; 50.5% vs. 5.8%, both P < 0.001), as well as superior renal ORR (94.0% vs. 75.7%, P < 0.001) and cardiac ORR (78.8% vs. 48.6%, P = 0.004). After a median follow-up of 63 months, the dFLC < 10 mg/L group showed longer median overall survival (OS) (not reached vs. 147 months, P < 0.001) and prolonged major organ deterioration-progression-free survival (MOD-PFS) (54 months vs. 28 months, P = 0.002). Multivariate analysis identified that early post-ASCT dFLC < 10 mg/L is an independent protective factor for MOD-PFS. In conclusion, the early post-ASCT achievement of dFLC < 10 mg/L predicts deeper responses, prolonged survival, and delayed progression in patients with AL amyloidosis undergoing ASCT. Clinicaltrials.gov: NCT04210791.
Keywords:
Light chain amyloidosis
Autologous stem cell transplantation
Serum free light chain
Difference between involved and uninvolved free light chains
Prognosis
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