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The impact of dialysis on the survival of patients with immunoglobulin light chain (AL) amyloidosis undergoing autologous stem cell transplantation

Nelson Leung, Shaji K Kumar, Siobhan V Glavey, Angela Dispenzieri, Martha Q Lacy, Francis K Buadi, Suzanne R Hayman, David Dingli, Prashant Kapoor, Steven R Zeldenrust, Stephen J Russell, John A Lust, William J Hogan, S Vincent Rajkumar, Dennis A Gastineau, Taxiarchis V Kourelis, Yi Lin, Wilson I Gonsalves, Ronald S Go, Morie A Gertz
Nephrology, Dialysis, Transplantation 2016, 31 (8): 1284-9
26627634

BACKGROUND: Acute renal failure requiring dialysis is associated with high mortality during autologous stem cell transplantation (ASCT). This study examined the association between acute renal failure and mortality in immunoglobulin light chain (AL) amyloidosis during ASCT.

METHODS: Between 1996 and 2010, 408 ASCT patients were evaluated. Data were collected from electronic medical records.

RESULTS: Dialysis was performed on 72 (17.6%) patients. Eight patients started dialysis >30 days prior to ASCT (Group II), 36 started ±30 days after ASCT (Group III) and 28 initiated dialysis >1 month after ASCT (Group IV). Patients who never dialyzed were assigned to Group I. There were no significant age or sex differences. Median overall survival (OS) had not been reached in Groups I and II but was 7.0 months in Group III and 48.5 months in Group IV (P < 0.001). Treatment-related mortality (TRM) was observed in 44.4% of the patients in Group III, 6-fold higher than the next highest group (P < 0.001). The most common causes of TRM were cardiac and sepsis. In the multivariate analysis, only hypoalbuminemia (<2.5 g/dL, P < 0.001) and estimated glomerular filtration rate (eGFR) <40 mL/min/1.73 m(2) (P < 0.001) were independently associated with starting dialysis within 30 days of ASCT.

CONCLUSIONS: The study found significant differences in the OS depending on when the acute renal failure occurred. Patients who required dialysis within 30 days of ASCT had the highest rate of TRM. Screening with serum albumin and eGFR may reduce the risk.

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