Translocation t(11;14) Is Associated With Adverse Outcome in Patients With Newly Diagnosed AL Amyloidosis When Treated With Bortezomib-Based Regimens

Abstract

iFISH results are important independent prognostic factors in AL amyloidosis. In contrast to our recently published results with melphalan and dexamethasone standard therapy, bortezomib is less beneficial to patients harboring t(11;14), whereas it effectively alleviates the poor prognosis inherent to high-risk aberrations. Given the discrepant response to different treatment modalities, iFISH may help to guide therapeutic choices in these poor-risk patients requiring rapid hematologic response.

Prognostic impact of cytogenetic aberrations in AL amyloidosis patients after high-dose melphalan: a long-term follow-up study

“…However, the responsiveness of t (11;14) to the melphalan-based regimens contrasts with the adverse prognostic effect of t (11;14) in bortezomib-treated cohorts previously reported by our group. 33 Nevertheless, we do not regard the 2 melphalan studies as contradictory to the bortezomib study. First, melphalan and bortezomib are distinct drugs with biologically different mechanisms of action.…”

“…Mayo stages I and II prevailed, and only a few patients met Mayo stage III criteria. 30 The median dFLC of 143.5 mg/L in the study group was below the published cutoff of 180 mg/L 31 and well below the median value observed for non-transplant cohorts at our center (181 mg/L in the melphalan-dexamethasone cohort 32 and 317 mg/L in the bortezomib study 33 ).…”

Improved outcomes for newly diagnosed AL amyloidosis between 2000 and 2014: cracking the glass ceiling of early death

“…Another potential explanation is the inferior outcomes seen in patients with t(11;14) treated with bortezomib. 24,25 This aspect of therapy requires more study.…”

Clarifying immunoglobulin gene usage in systemic and localized immunoglobulin light-chain amyloidosis by mass spectrometry

“…Of 701 AL S patients, 463 (66%) had dFLC levels available at diagnosis. Finally, because bone marrow FISH has been associated with organ involvement and prognosis in AL S , [18][19][20] we examined whether there was any differential IGVL gene usage according to bone marrow FISH.…”