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Stem Cell Rescue Not Beneficial in AL Amyloidosis

Survival is lower with high-dose chemotherapy plus rescue than with standard chemotherapy

WEDNESDAY, Sept. 12 (HealthDay News) -- In patients with systemic immunoglobulin-light-chain amyloidosis, treatment with high-dose melphalan plus autologous stem cell rescue is not superior to treatment with standard chemotherapy, according to a report in the Sept. 13 issue of the New England Journal of Medicine.

Arnaud Jaccard, M.D., of the Centre Hospitalier Universitaire in Limoges, France, and colleagues randomly assigned 100 patients aged 18 to 70 to receive either high-dose intravenous melphalan followed by autologous hematopoietic stem cell rescue or standard-dose oral melphalan and high-dose dexamethasone. The patients were followed for a median of three years.

The investigators found that estimated median survival in the standard-dose oral melphalan and high-dose dexamethasone group was significantly higher than in the high-dose intravenous melphalan followed by autologous hematopoietic stem cell rescue group (56.9 months versus 22.2 months). They also found that there were no significant group differences in treatment response rates.

"A trial comparing the two treatments in a tertiary referral center, where the treatment-related mortality rate is likely to be lower, may have different results," the authors state.

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