Open AccessHigh-Dose Melphalan and Autologous Peripheral Blood Stem Cell Transplantation in AL Amyloidosis
Author(s) -
Vaishali Sanchorawala
Publication year - 2020
Publication title -
acta haematologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 56
eISSN - 1421-9662
pISSN - 0001-5792
DOI - 10.1159/000506498
Subject(s) - melphalan , al amyloidosis , plasma cell dyscrasia , medicine , autologous stem cell transplantation , multiple myeloma , amyloidosis , stem cell , transplantation , dyscrasia , oncology , surgery , plasma cell , immunology , biology , genetics , antibody , immunoglobulin light chain
AL amyloidosis is a systemic amyloidosis and is associated with an underlying plasma cell dyscrasia. High-dose intravenous melphalan and autologous stem cell transplantation was developed for the treatment of AL amyloidosis in the early 1990s and was prompted by its success in myeloma. This application has evolved significantly over the past three decades. This review provides a comprehensive assessment of eligibility criteria, stem cell collection, and mobilization strategies and regimens, risk-adapted melphalan dosing, role for induction and consolidation therapies as well as long-term outcome with respect to survival, hematologic response and relapse as well as organ responses following stem cell transplantation. Continued efforts to refine patient selection and management, and incorporate novel anti-plasma cell agents in combination or sequentially to further improve outcomes in AL amyloidosis are also discussed.