The impact of Post-Transplant doxycycline in AL amyloidosis - updated results after Long-Term follow up.

IF 5.2 2区医学 Q1 BIOCHEMISTRY & MOLECULAR BIOLOGY

Amyloid-Journal of Protein Folding Disorders Pub Date : 2023-09-01 DOI:10.1080/13506129.2022.2155809

Nadine Abdallah, Angela Dispenzieri, Eli Muchtar, Francis K Buadi, Prashant Kapoor, Martha Q Lacy, Yi L Hwa, Amie Fonder, Miriam A Hobbs, Suzanne R Hayman, Nelson Leung, David Dingli, Ronald S Go, Yi Lin, Wilson I Gonsalves, Moritz Binder, Taxiarchis Kourelis, Rahma Warsame, Robert A Kyle, S Vincent Rajkumar, Morie A Gertz, Shaji K Kumar

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引用次数: 2

Abstract

Introduction: The current treatment paradigm of AL amyloidosis lacks effective fibril-directed therapies. Doxycycline has been shown to have anti-fibril properties in preclinical models. In 2012, we reported that posttransplant prophylaxis with doxycycline was associated with improved survival compared to penicillin in patients with haematologic response. We provide here updated results after long-term follow up.

Methods: We included 553 patients who underwent transplant between July 24^th, 1996, and June 24^th, 2014. Doxycycline 100 mg daily was used for prophylaxis in patients with penicillin allergy; since 2013, doxycycline was used as the standard for prophylaxis. Prophylaxis was typically continued for a year after transplant.

Results: The median follow-up from transplant was 12.7 years. Doxycycline was used for prophylaxis in 33% of patients; the rest received penicillin. The median time to next treatment was 6.0 (95%CI; 4.4-8.8) years and 6.0 (95%CI; 4.9-7.1) years in the doxycycline and penicillin groups, respectively (p = .89). The median overall survival was 12.0 (95%CI: 11.0-19.6) years and 11.0 (95%CI: 9.6-12.7) years in the 2 groups, respectively (p = .17). There was a minimal trend towards improved survival with doxycycline among patients with ≥ very good partial response and among patients with organ response that was not statistically significant.

Conclusion: After long-term follow-up, there is no clear evidence to support benefit of doxycycline in the post-transplant setting.

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移植后强力霉素对AL淀粉样变性的影响——长期随访后的最新结果。

目前AL淀粉样变性的治疗模式缺乏有效的原纤维定向治疗。多西环素在临床前模型中显示出抗纤维特性。2012年，我们报道了与青霉素相比，移植后预防多西环素可提高血液学反应患者的生存率。我们在此提供长期随访后的最新结果。方法:纳入1996年7月24日至2014年6月24日期间接受移植的553例患者。预防青霉素过敏患者多用多西环素100 mg / d;2013年起，多西环素作为预防用药标准。预防通常在移植后持续一年。结果:移植后的中位随访时间为12.7年。33%的患者使用强力霉素进行预防;其余患者接受青霉素治疗。到下一次治疗的中位时间为6.0 (95%CI;4.4-8.8)年和6.0年(95%CI;多西环素组和青霉素组分别为4.9 ~ 7.1年(p = 0.89)。两组患者的中位总生存期分别为12.0 (95%CI: 11.0 ~ 19.6)年和11.0 (95%CI: 9.6 ~ 12.7)年(p = 0.17)。在部分反应≥非常好的患者和器官反应的患者中，多西环素改善生存的趋势最小，无统计学意义。结论:经过长期随访，没有明确的证据支持强力霉素在移植后环境中的益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Amyloid-Journal of Protein Folding Disorders 生物-生化与分子生物学

CiteScore

10.60

自引率

10.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Amyloid: the Journal of Protein Folding Disorders is dedicated to the study of all aspects of the protein groups and associated disorders that are classified as the amyloidoses as well as other disorders associated with abnormal protein folding. The journals major focus points are: etiology, pathogenesis, histopathology, chemical structure, nature of fibrillogenesis; whilst also publishing papers on the basic and chemical genetic aspects of many of these disorders. Amyloid is recognised as one of the leading publications on amyloid protein classifications and the associated disorders, as well as clinical studies on all aspects of amyloid related neurodegenerative diseases and major clinical studies on inherited amyloidosis, especially those related to transthyretin. The Journal also publishes book reviews, meeting reports, editorials, thesis abstracts, review articles and symposia in the various areas listed above.