https://orcid.org/0000-0003-2210-2174
Key Points
ASCT for AL amyloidosis decreased significantly (71% average annual reduction) with the introduction of Dara-CyBorD
ASCT now targets patients with suboptimal response, relapsed/refractory disease, lymphoplasmacytic clone, or higher plasma cell burden
This retrospective analysis examined 15 years of autologous stem cell transplantation (ASCT) for AL amyloidosis at Mayo Clinic (2010-2024). We aimed to assess ASCT utilization trends, factors influencing practice changes, and current indications amid newer therapies. 441 ASCTs were divided into Cohort 1 (2010-2019) and Cohort 2 (2020-2024), revealing a significant ASCT reduction in Cohort 2 (385 vs. 56, average 71% annual decrease). Cohort 2 patients were older, more likely to have relapsed/refractory disease, and had higher baseline bone marrow plasma cell burden compared to Cohort 1. Pre-ASCT induction was more frequent in Cohort 2 (89.3% vs. 56.6%), with Dara-CyBorD replacing CyBorD as the predominant induction regimen. Lymphoma-based regimens were also more common in Cohort 2 (15.1% vs 5.3% P=0.02). Day-100 satisfactory hematological response improved in Cohort 2 (91.1% vs. 72.7%, P=0.001), though hematological complete response rates did not significantly differ (50.9% vs 38.3%, P=0.09). The superior hematological responses with Daratumumab-based regimens reduced ASCT need. In summary, there is a decrease in the utilization of ASCT in AL amyloidosis, this procedure is primarily reserved for patients with suboptimal responses, relapsed/refractory disease, lymphoplasmacytic clones (predominantly IgM amyloidosis), or high bone marrow plasma cell burden (myeloma phenotype). This study underscores a significant shift in ASCT practice, driven by novel therapies, emphasizing more personalized management in AL amyloidosis.
