Background: We investigated how kidney function impacted progression-free survival (PFS) and overall survival (OS) after autologous stem cell transplantation (ASCT) in patients with AL amyloidosis.
Methods: We performed a retrospective cohort study of 314 patients with AL amyloidosis who underwent ASCT between 2010 and 2020. In addition to the baseline demographics, comorbidities, and kidney amyloidosis stage, eGFR) and other laboratory values were collected at day 0, day 100, 6 months, 1 year, 2 years, and 3 years after ASCT. The Cox proportional hazards models were used to estimate hazard ratio based on landmark analysis for the effects of eGFR and other longitudinal measures on PFS or OS.
Results: Higher eGFR values at all time points after ASCT were not significantly associated with longer PFS but was associated with increased OS. Patients with kidney amyloidosis stage III at baseline had inferior OS compared to those who had stage I [HR (95% CI) = 9.428 (1.134, 78.381), p-value = 0.0379]. OS was better in those who had complete kidney response irrespective of the baseline kidney amyloidosis stage, compared to those without response [HR (95% CI) = 7.581 (2.042, 28.149), p = 0.0025].
Conclusions: This retrospective study shows that kidney function has an impact on survival in patients with AL amyloidosis who undergo ASCT. Both higher eGFR at baseline and complete kidney response after ASCT favor improved survival outcomes.
Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology.