Graded cardiac response criteria for patients with systemic light chain amyloidosis

• Verfasst von: Muchtar, Eli [VerfasserIn]
• Verfasst von: Dispenzieri, Angela [VerfasserIn]
• Verfasst von: Wisniowski, Brendan [VerfasserIn]
• Verfasst von: Palladini, Giovanni [VerfasserIn]
• Verfasst von: Milani, Paolo [VerfasserIn]
• Verfasst von: Merlini, Giampaolo [VerfasserIn]
• Verfasst von: Schönland, Stefan [VerfasserIn]
• Verfasst von: Veelken, Kaya [VerfasserIn]
• Verfasst von: Hegenbart, Ute [VerfasserIn]
• Verfasst von: Geyer, Susan M. [VerfasserIn]
• Verfasst von: Kumar, Shaji K. [VerfasserIn]
• Verfasst von: Kastritis, Efstathios [VerfasserIn]
• Verfasst von: Dimopoulos, Meletios A. [VerfasserIn]
• Verfasst von: Liedtke, Michaela [VerfasserIn]
• Verfasst von: Witteles, Ronald [VerfasserIn]
• Verfasst von: Sanchorawala, Vaishali [VerfasserIn]
• Verfasst von: Szalat, Raphael [VerfasserIn]
• Verfasst von: Landau, Heather [VerfasserIn]
• Verfasst von: Petrlik, Erica [VerfasserIn]
• Verfasst von: Lentzsch, Suzanne [VerfasserIn]
• Verfasst von: Coltoff, Alexander [VerfasserIn]
• Verfasst von: Bladé, Joan [VerfasserIn]
• Verfasst von: Cibeira, Maria Teresa [VerfasserIn]
• Verfasst von: Cohen, Oliver [VerfasserIn]
• Verfasst von: Foard, Darren [VerfasserIn]
• Verfasst von: Wechalekar, Ashutosh [VerfasserIn]
• Verfasst von: Gertz, Morie A. [VerfasserIn]
• Titel: Graded cardiac response criteria for patients with systemic light chain amyloidosis
• Verf.angabe: Eli Muchtar, MD; Angela Dispenzieri, MD; Brendan Wisniowski, MBBS; Giovanni Palladini, MD, PhD; Paolo Milani, MD, PhD; Giampaolo Merlini, MD; Stefan Schönland, MD; Kaya Veelken, MD; Ute Hegenbart, MD; Susan M. Geyer, PhD; Shaji K. Kumar, MD; Efstathios Kastritis, MD; Meletios A. Dimopoulos, MD; Michaela Liedtke, MD; Ronald Witteles, MD; Vaishali Sanchorawala, MD; Raphael Szalat, MD; Heather Landau, MD; Erica Petrlik, MD; Suzanne Lentzsch, MD, PhD; Alexander Coltoff, MD; Joan Bladé, MD, PhD; Maria Teresa Cibeira, MD, PhD; Oliver Cohen, MD; Darren Foard, MD; Ashutosh Wechalekar, MD; and Morie A. Gertz, MD
• Jahr: 2023
• Umfang: 12 S.
• Fussnoten: Online veröffentlicht October 10, 2022 ; Gesehen am 27.11.2023
• Titel Quelle: Enthalten in: Journal of clinical oncology
• Ort Quelle: Alexandria, Va. : American Society of Clinical Oncology, 1983
• Jahr Quelle: 2023
• Band/Heft Quelle: 41(2023), 7 vom: März, Seite 1393-1403
• ISSN Quelle: 1527-7755
• DOI: doi:10.1200/JCO.22.00643
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1871228239

Abstract

PURPOSE - - Binary cardiac response assessment using cardiac biomarkers is prognostic in light chain amyloidosis. Previous studies suggested four-level cardiac responses using N-terminal prohormone of brain natiuretic peptide improves prognostic prediction. This study was designed to validate graded cardiac response criteria using N-terminal prohormone of brain natiuretic peptide/brain natiuretic peptide. - - PATIENTS AND METHODS - - This retrospective, multicenter study included patients with light chain amyloidosis who achieved at least a hematologic partial response (PR) and were evaluable for cardiac response. Four response criteria were tested on the basis of natriuretic peptide response depth: cardiac complete response (CarCR), cardiac very good partial response (CarVGPR), cardiac PR (CarPR), and cardiac no response (CarNR). Response was classified as best response and at fixed time points (6, 12, and 24 months from therapy initiation). The study primary outcome was overall survival. - - RESULTS - - 651 patients were included. Best CarCR, CarVGPR, CarPR, and CarNR were achieved in 16%, 26.4%, 22.9%, and 34.7% of patients, respectively. Patients in cardiac stage II were more likely to achieve CarCR than patients in cardiac stage IIIA and IIIB (22% v 13.5% v 3.2%; P < .001). A deeper cardiac response was associated with a longer survival (5-year overall survival 93%, 79%, 65%, and 33% for CarCR, CarVGPR, CarPR, and CarNR, respectively; P < .001). Fixed time-point analyses and time-varying covariates Cox regression analysis, to minimize survivorship bias, affirmed the independent survival advantage of deeper cardiac responses. Four-level response performed better than two-level response as early as 12 months from therapy initiation. - - CONCLUSION - - Graded cardiac response criteria allow better assessment of cardiac improvement compared with the traditional binary response system. The study re-emphasizes the importance of early diagnosis, which increases the likelihood of deep cardiac responses.