Table 7. Primary treatment of AL:... | American Society of Hematology

Table 7.

Primary treatment of AL: advantages and disadvantages of main regimens.

Regimen	Hematologic   Response %  (CR)	Organ   Response %	Median Time to  Hematologic  Response (mo)	TRM %	Advantages	Disadvantages
† Data from the SWOG study using intensive HD-Dex induction followed by maintenance with HD-Dex and interferon.
* In the study conducted at the Pavia Centre thalidomide was associated with intermediate dose dexamethasone; in the study conducted at the London Centre 51 patients were treated with thalidomide alone, and 29 patients were treated with thalidomide in association with dexamethasone and/or other alkylating agents.
Abbreviations: TRM, treatment-related mortality; NR, not reported; PBSCT, peripheral blood stem cell transplantation; MDex, melphalan and dexamethasone; VAD, vincristine, doxorubicin, dexamethasone; HD-DEX, high-dose dexamethasone; MP, melphalan and prednisone
PBSCT	45–60 (14–36)	34–55	3–4	13–14	high response rate, improved quality of life, prolonged survival	TRM and morbidity  still significant limited patient eligibility
MDex	67 (33)	48	4.5	4	significant response rate, low toxicity applicable to most AL  patients	limited experience depletion of stem cells
VAD	54 (NR)	50	NR	7	significant response rate no depletion of stem cells	patient selection   (vincristine is a poor  choice in amyloid  neuropathy and  doxorubicin in amyloid  cardiomyopathy) significant TRM
HD-Dex	40–53†   (16–24†)	12–45†	4	7	significant response rate no depletion of stem cells	response rate   improvable low response rate in  cardiac amyloid significant heart-related  TRM
MP	28–36   (uncommon)	25–30	7–11	low ~ 2	low toxicity well tolerated can be applied in virtually  all patients	low response rate unacceptably long time to  achieve a response
Thalidomide*	25–69   (0–19)	25–30	4	low 0–3	significant response rate likely less marrow  suppression	limited tolerability due to  severe toxicity

Regimen	Hematologic   Response %  (CR)	Organ   Response %	Median Time to  Hematologic  Response (mo)	TRM %	Advantages	Disadvantages
† Data from the SWOG study using intensive HD-Dex induction followed by maintenance with HD-Dex and interferon.
* In the study conducted at the Pavia Centre thalidomide was associated with intermediate dose dexamethasone; in the study conducted at the London Centre 51 patients were treated with thalidomide alone, and 29 patients were treated with thalidomide in association with dexamethasone and/or other alkylating agents.
Abbreviations: TRM, treatment-related mortality; NR, not reported; PBSCT, peripheral blood stem cell transplantation; MDex, melphalan and dexamethasone; VAD, vincristine, doxorubicin, dexamethasone; HD-DEX, high-dose dexamethasone; MP, melphalan and prednisone
PBSCT	45–60 (14–36)	34–55	3–4	13–14	high response rate, improved quality of life, prolonged survival	TRM and morbidity  still significant limited patient eligibility
MDex	67 (33)	48	4.5	4	significant response rate, low toxicity applicable to most AL  patients	limited experience depletion of stem cells
VAD	54 (NR)	50	NR	7	significant response rate no depletion of stem cells	patient selection   (vincristine is a poor  choice in amyloid  neuropathy and  doxorubicin in amyloid  cardiomyopathy) significant TRM
HD-Dex	40–53†   (16–24†)	12–45†	4	7	significant response rate no depletion of stem cells	response rate   improvable low response rate in  cardiac amyloid significant heart-related  TRM
MP	28–36   (uncommon)	25–30	7–11	low ~ 2	low toxicity well tolerated can be applied in virtually  all patients	low response rate unacceptably long time to  achieve a response
Thalidomide*	25–69   (0–19)	25–30	4	low 0–3	significant response rate likely less marrow  suppression	limited tolerability due to  severe toxicity