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Delayed autologous stem cell transplantation following cardiac transplantation experience in patients with cardiac amyloidosis
Author(s) -
Trachtenberg Barry H.,
Kamble Rammurti T.,
Rice Lawrence,
AraujoGutierrez Raquel,
Bhimaraj Arvind,
Guha Ashrith,
Park Myung H.,
Hussain Imad,
Bruckner Brian A.,
Suarez Erik E.,
Victor David W.,
Adrogue Horacio E.,
Baker Kelty R.,
Estep Jerry D.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15487
Subject(s) - medicine , autologous stem cell transplantation , cardiac amyloidosis , amyloidosis , al amyloidosis , transplantation , surgery , heart transplantation , primary systemic amyloidosis , retrospective cohort study , disease , immunoglobulin light chain , systemic disease , antibody , immunology
This study sought to retrospectively investigate the outcomes of patients with light‐chain amyloidosis ( AL ) with advanced cardiac involvement who were treated with a strategy of heart transplantation ( HT ) followed by delayed autologous stem cell transplantation ( ASCT ) at 1‐year posttransplant. Patients with AL amyloidosis with substantial cardiac involvement have traditionally had very poor survival (eg, several months). A few select centers have reported their outcomes for HT followed by a strategy of early ASCT (ie, 6 months) for CA . The outcomes of patients undergoing a delayed strategy have not been reported. All patients with AL amyloidosis at a single institution undergoing evaluation for HT from 2004‐2018 were included. Retrospective analyses were performed. Sixteen patients underwent HT (including two combined heart‐kidney transplant) for AL amyloidosis. ASCT was performed in a total of nine patients to date at a median 13.5 months (12.8‐32.9 months) post‐ HT . Survival was 87.5% at 1 year and 76.6% at 5 years, comparable to institutional outcomes for nonamyloid HT recipients. In addition to these 16 patients, two patients underwent combined heart‐lung transplantation. A strategy of delayed ASCT 1‐year post‐ HT for patients with AL amyloidosis is feasible, safe, and associated with comparable outcomes to those undergoing an earlier ASCT strategy.