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M.H. Sidiqi et al.
Figure 2. Landmark survival analysis from 100 days post stem cell transplant by hematologic response. CR: complete response; VGPR: very good partial response; PR: partial response; NR: no response; PCPI: plasma cell proliferation index; OS: overall survival; N: number.
Table 3. Prognostic factors for survival. Variable
Age ≥65
Male
BMPCs ≥10
PCPI elevated
Mayo stage 2012 III/IV vs. I/II Mayo Stage 2004 III vs. I/II
Univariate Multivariate Model A Multivariate Model B P HR P HR P HR
0.0074 1.6 (1.1-2.1) 0.014 1.4 (1.1-2.0) 0.0033 1.5 (1.2-2.1) 0.0005 1.7 (1.3-2.3) <0.0001 3.5 (2.5-4.8) <0.0001 0.3 (0.2-0.4) <0.0001 0.3 (0.3-0.5)
Between 1st January 2003 and 31st of August 2016 548 patients with systemic AL amyloidosis underwent ASCT at the Mayo Clinic in Rochester, for 94% of whom (n=513) data were available on bone marrow PCPI per- formed at diagnosis and 6% (n=35) had insufficient plas- ma cells on bone marrow biopsy for accurate assessment of PCPI. Of those with a reported PCPI, 68% (n=348) had a Low PCPI and 32% (n=165) had an Elevated PCPI. Table 1 summarizes the baseline characteristics for each group of patients. Median age and proportion of males in the Low PCPI group was similar to those with an Elevated PCPI: 59 vs. 58 years (P=0.26) and 64% vs. 63% (P=0.77), respectively.
Patients with an Elevated PCPI had more cardiac involvement (56% vs. 44%; P=0.01) and less renal
NS - NS - NS - NS - NS - NS -
1232
Conditioning dose 200 vs. <200
BMPCs: bone marrow plasma cells; PCPI: plasma cell proliferation index; NS: not significant; HR: Hazard Ratio.
0.021
<0.0001
Not included
1.5 (1.1-2.1)
0.019 Not included 0.0006 <0.0001
1.5 (1.1-2.1) -
2.0 (1.3-2.8) 0.4 (0.3-0.6)
2.3 (1.6-3.3)
-
<0.0001
0.4 (0.3-0.6)
Results
involvement (55% vs. 70%; P=0.001). The number of organs involved was similar between the two groups. Bone marrow plasma cell burden was higher in the Elevated PCPI group with 58% of patients having BMPCs of 10% or over compared to 32% in the Low PCPI group (P<0.0001). A higher plasma cell percentage would be expected in the former group given the higher proliferative capacity of the plasma cell clone. More patients had a Mayo Stage of II or more in the Elevated PCPI group (65% elevated PCPI vs. 52% low PCPI; P=0.008). Fewer patients in the Elevated PCPI group received full intensity (melphalan 200 mg/m2) condition- ing (63% Elevated PCPI vs. 74% Low PCPI; P=0.02). Reduced intensity conditioning (melphalan <200 mg/m2) was given to patients aged 70 years or older and those with creatinine over 1.8 mg/dL. More patients received pre-transplant chemotherapy in the Elevated PCPI group
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