Outcomes of bortezomib combination chemotherapies in autologous stem cell transplantation-ineligible patients with AL amyloidosis
Joon Young Hur1*, Sang Eun Yoon2*, Darae Kim3, Jin-oh Choi3, Ju-Hong Min4, Byung Jun Kim4, Jung Sun Kim5, Jung Eun Lee6, Joon Young Choi7, Eun-Seok Jeon3, Seok Jin Kim2, Kihyun Kim2
1Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, 2Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 3Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 4Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 5Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 6Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 7Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence to: Kihyun Kim, M.D., Ph.D.
Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-Gu, Seoul 06351, Korea
E-mail kihyunkimk@gmail.com or kihyunk@skku.edu
*These authors contributed equally to this work.
Published online: November 22, 2021.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background: Treatment protocols for light chain (AL) amyloidosis have been derived from myeloma treatment. Bortezomib is a key drug used for the treatment of myeloma and AL amyloidosis. We retrospectively investigated the efficacy and toxicity of bortezomib-based chemotherapy in patients with newly diagnosed AL amyloidosis.
Methods: We reviewed the outcomes of newly diagnosed autologous stem cell transplantation (auto- SCT)-ineligible AL amyloidosis patients who received bortezomib-based chemotherapy at a referral center between 2011 and 2017.
Results: Of 63 patients who received bortezomib-based chemotherapy, 32 were male, and the median age was 66 years (range, 42–82 yr). The hematologic overall response rate (ORR) was 65.1%, and the chemotherapy regimen with the best hematologic response was VMP (75.7%, 28/37), followed by VCD (62.5%, 5/8). Sixty patients had significant organ (heart or kidney) involvement; 28.3% of patients (N=17) had major organ responses after chemotherapy. With a median follow-up of 34 months, there was no significant difference in progression-free survival (P=0.49) or overall survival (P=0.67) according to regimen. Most hematologic and non-hematologic problems were manageable.
Conclusion: Various chemotherapy combinations based on bortezomib are currently employed in the clinical setting, but no difference was found in terms of efficacy or toxicity.
Keywords: Bortezomib, Light-chain amyloidosis, Transplant ineligible


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