Adding Cyclophosphamide to Bortezomib and Dexamethasone was not Associated With Improved Outcomes of Patients With Newly Diagnosed Light Chain Amyloidosis: A Retrospective Study |
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| Institution: | 1. Department of Hematology and Medical Oncology, University of South Florida/ H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;2. Morsani College of Medicine, University of South Florida, Tampa, FL;3. Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;4. Department of Bone Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;5. Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;1. Department of Internal Medicine, Division of Hematology, School of Medicine, Akdeniz University, Antalya, Turkey;2. Department of Dermatology and Venereology, School of Medicine, Akdeniz University, Antalya, Turkey;1. Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, Bari, Italy;2. Pathology Unit, AOUC Policlinico, Bari, Italy;3. Clinical Pathology Unit, AOUC Policlinico, Bari, Italy;1. Leukemia/BMT Program of BC, BC Cancer, Vancouver, BC, Canada;2. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada;3. Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada;4. Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada;5. Division of Infectious Diseases, Department of Medicine, University of Alberta, AB, Edmonton, Canada;6. Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;7. Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute; Morsani College of Medicine, University of South Florida, Tampa, FL, USA;1. Yale University School of Medicine, New Haven CT, USA;2. University of Miami School of Medicine, Miami, Florida, USA;3. Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA;4. Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA;5. Department of Hematopathology, Yale University School ofMedicine, New Haven, CT, USA;1. Section of Hematology, Department of Internal Medicine, Yale University and Yale Cancer Center, New Haven, CT;2. Oregon Health & Science University, Portland, OR;3. Georgia Cancer Specialists, Marietta, GA;4. Berenson Oncology, West Hollywood, CA;5. Greenville Health System Cancer Institute, Greenville, SC;6. Department of Internal Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN;7. Incyte Corporation, Wilmington, DE;8. Incyte Corporation, Geneva, Switzerland |
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| Abstract: | IntroductionBefore 2021, the combination of bortezomib, cyclophosphamide, and dexamethasone (VCd) was one of the most used upfront therapy for systemic immunoglobulin light chain (AL) amyloidosis. Recently, daratumumab in combination with VCd resulted in improved outcomes compared to VCd. However, it's still unclear the role of cyclophosphamide in this combination.Materials and MethodsWe conducted this retrospective single-institutional study to compare the outcomes of upfront bortezomib and dexamethasone with or without cyclophosphamide (VD vs. VCd).ResultsOf 136 total patients, 62 received VD and 74 received VCd. The median age was 64 and the median number of organs involved was 2. Hematologic response was achieved among 73.4% patients in the VD arm and 85.9% in the VCd arm at 3 months (P = .15). Best organ response was not different between 2 arms (34.1% vs. 52.9% for VD and VCd arms, respectively; P = .28). After a median follow-up of 24.4 months, 2-year OS for VD and VCd arm was 70.6% and 84.6% respectively. The median overall survival was 70 months for VD arm and not reached for VCd arm (P = .30). There was no statistically significant difference in median time to next therapy (9.3 vs. 13.5 months for VD and VCd arms, respectively. P = .99).Conclusionthe addition of cyclophosphamide to VD was not associated with improved outcomes of patients with AL amyloidosis in this retrospective study. |
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