Submitted June 22, 2006
Accepted July 24, 2006
Successful treatment of AL amyloidosis patients over age 65 with high-dose melphalan and autologous stem cell transplantation
David C. Seldin*, Jennifer J. Anderson, Martha Skinner, Karim Malek, Daniel G. Wright, Karen Quillen, Kathleen Finn, Betul Oran, and Vaishali Sanchorawala
Boston University Medical Center, Boston, MA
Boston University School of Public Health, Boston, MA
* Corresponding author; email: dseldin{at}bumc.bu.edu.
Recently, protocols using high-dose melphalan chemotherapy and autologous peripheral blood stem cell transplantation (HDM/SCT) have been developed for the treatment of patients with AL amyloidosis. Although peri-transplant mortality is greater than for other hematologic diseases, treatment leads to durable hematologic complete responses, improvements in organ function and quality of life, and extended survival in a substantial proportion of patients. To determine whether this treatment can be applied to older patients, we have analyzed HDM/SCT treatment outcomes for sixty-five AL amyloidosis patients over 65 years of age compared with outcomes for 280 younger patients. For patients over age 65 who meet the same eligibility criteria as younger patients, toxicity, hematologic remission rate, and survival was not significantly different from those observed in younger patients, indicating that older patients should not be excluded a priori from consideration for HDM/SCT treatment.
