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The following is the summary of “Long-term outcomes of renal AL amyloidosis patients undergoing autologous stem cell transplantation: Validating the performance of the renal staging system,” published in the August 2024 issue of Hematology by Muchtar et al.

Renal AL amyloidosis can lead to end-stage renal disease (ESRD), which may require renal replacement therapy (RRT). 

Researchers conducted a retrospective study analyzing the long-term outcomes for patients with renal AL amyloidosis who had autologous stem cell transplantation (ASCT) and evaluated the effectiveness of the renal staging system.

They looked at 697 patients with renal AL who had ASCT from 2003 to 2020 at Mayo Clinic and Boston University. 24-hour proteinuria and estimated glomerular filtration rate were used to determine the renal stage, tracking survival from ASCT until RRT started or the last follow-up for patients not needing RRT.

The results showed that in the median follow-up of 10.4 years, 21% of patients (n=149) required RRT. The median time from ASCT to ESRD was 3.4 years, with some cases occurring more than 10 years after ASCT. The 3-year RRT rates were 3% for stage I, 10% for stage II, and 37% for stage III. However, in the 2012-2020 period, RRT risk decreased across all stages (0% for stage I, 5% for stage II, and 24% for stage III). Multivariate analysis found that pre-ASCT renal stage, lambda isotype, bone marrow plasmacytosis ≥20%, post-ASCT hematologic response, and year of ASCT were independently linked to renal survival.

Investigators concluded that renal stage is a dependable predictor of outcomes for renal AL amyloidosis patients treated with ASCT. Despite fewer patients needing RRT recently, the pre-ASCT renal stage remains key in forecasting results.

Source: onlinelibrary.wiley.com/doi/abs/10.1002/ajh.27460