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.