Blood Journal
Leading the way in experimental and clinical research in hematology

Cyclophosphamide-bortezomib-dexamethasone (CYBORD) produces rapid and complete hematological response in patients with AL amyloidosis

  1. Joseph R Mikhael1,*,
  2. Steven R Schuster1,
  3. Victor H Jimenez-Zepeda2,
  4. Nancy Bello1,
  5. Jacy Spong1,
  6. Craig B Reeder1,
  7. A Keith Stewart1,
  8. P Leif Bergsagel1, and
  9. Rafael Fonseca1
  1. 1 Mayo Clinic in Arizona, Scottsdale, AZ, United States;
  2. 2 Princess Margaret Hospital, Toronto, ON, Canada
  1. * Corresponding author; email: mikhael.joseph{at}


Cyclophosphamide, bortezomib, and dexamethasone (CyBorD) is highly effective in multiple myeloma. We treated patients with AL amyloidosis prior to stem cell transplantation (ASCT), instead of ASCT in ineligible patients or as salvage. Treatment was a combination of bortezomib (1.5 mg/m2 weekly), cyclophosphamide (300 mg/m2 orally weekly) and dexamethasone (40 mg weekly). Seventeen patients received 2-6 cycles of CyBorD. Ten (58%) had symptomatic cardiac involvement and 14 (82%) had 2 or more organs involved. Response occurred in 16 (94%), with 71% achieving complete hematological response and 24% a partial response. Time to response was 2 months. Three patients originally not eligible for ASCT became eligible. CyBorD produces rapid and complete hematological responses in the majority of patients with AL regardless of previous treatment or ASCT candidacy. It is well tolerated with few side effects. CyBorD warrants continued investigation as treatment for AL.

  • Submitted November 17, 2011.
  • Accepted January 18, 2012.