{"title":"Outcomes of BTD vs. BCD as initial treatment of renal amyloid light-chain amyloidosis: a retrospective cohort study in China.","authors":"Sheng Li, Weiting He, Hok-Him Yau, Jianteng Xie, Yaxi Zhu, Xiaojie Chen, Shaogui Zhang, Yifan Zhang, Pengjun Liao, Hui Liu, Liwen Li, Liye Zhong, Wenjian Wang","doi":"10.1080/0886022X.2025.2453006","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To compare the efficacy and safety of bortezomib with thalidomide and dexamethasone (BTD) and bortezomib with cyclophosphamide and dexamethasone (BCD) as the initial treatment for renal amyloid light chain (AL) amyloidosis in Chinese cohort.</p><p><strong>Methods: </strong>A cohort of 174 patients with AL amyloidosis was studied in Guangdong Provincial People's Hospital from January 2008 to August 2023. Propensity-score matching cases were applied to assess the outcomes of patients treated with BTD and BCD regimen. Primary outcomes were patients achieving hematologic response and organ responses, and the secondary endpoints were patients progressing to end-stage renal disease or all-cause death.</p><p><strong>Results: </strong>44 Patients were included. The hematologic complete response rate (CR) in the BTD group was comparable between the groups of BTD group and BCD. However, the time to achieve hematologic CR was significantly shorter in the BTD group compared to the BCD group (4.97 vs. 7.71 mon, <i>p</i> = 0.010). Furthermore, when reaching hematologic response, the cumulative dose of bortezomib that standardized by body surface area (BSA) was lower in BTD group than in the BCD group (10.4 vs. 15.6 mg/m<sup>2</sup>, <i>p</i> = 0.013). There was no significant difference of renal and cardiac response between groups. However, post-treatment proteinuria levels after treatment were significantly lower in the BTD group compared to those in the BCD group (747 mg/24h vs. 2928 mg/24h, <i>p</i> = 0.048).</p><p><strong>Conclusions: </strong>Compared to BCD regimen for renal AL amyloidosis, initial treatment with BTD regimen demonstrated similar rates of hematologic CR but showed superior reduction in proteinuria, reduced cumulative dose of bortezomib and faster time-to-response.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2453006"},"PeriodicalIF":3.0000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863997/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Renal Failure","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/0886022X.2025.2453006","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/24 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To compare the efficacy and safety of bortezomib with thalidomide and dexamethasone (BTD) and bortezomib with cyclophosphamide and dexamethasone (BCD) as the initial treatment for renal amyloid light chain (AL) amyloidosis in Chinese cohort.
Methods: A cohort of 174 patients with AL amyloidosis was studied in Guangdong Provincial People's Hospital from January 2008 to August 2023. Propensity-score matching cases were applied to assess the outcomes of patients treated with BTD and BCD regimen. Primary outcomes were patients achieving hematologic response and organ responses, and the secondary endpoints were patients progressing to end-stage renal disease or all-cause death.
Results: 44 Patients were included. The hematologic complete response rate (CR) in the BTD group was comparable between the groups of BTD group and BCD. However, the time to achieve hematologic CR was significantly shorter in the BTD group compared to the BCD group (4.97 vs. 7.71 mon, p = 0.010). Furthermore, when reaching hematologic response, the cumulative dose of bortezomib that standardized by body surface area (BSA) was lower in BTD group than in the BCD group (10.4 vs. 15.6 mg/m2, p = 0.013). There was no significant difference of renal and cardiac response between groups. However, post-treatment proteinuria levels after treatment were significantly lower in the BTD group compared to those in the BCD group (747 mg/24h vs. 2928 mg/24h, p = 0.048).
Conclusions: Compared to BCD regimen for renal AL amyloidosis, initial treatment with BTD regimen demonstrated similar rates of hematologic CR but showed superior reduction in proteinuria, reduced cumulative dose of bortezomib and faster time-to-response.
目的：比较硼替佐米联合沙利度胺和地塞米松（BTD）和硼替佐米联合环磷酰胺和地塞米松（BCD）治疗肾淀粉样蛋白轻链（AL）淀粉样变性的疗效和安全性。方法：对2008年1月至2023年8月广东省人民医院174例AL淀粉样变患者进行队列研究。采用倾向评分匹配病例评估BTD和BCD方案治疗患者的预后。主要终点是患者达到血液学反应和器官反应，次要终点是患者进展到终末期肾脏疾病或全因死亡。结果：共纳入44例患者。BTD组血液学完全缓解率（CR）在BTD组和BCD组之间具有可比性。然而，与BCD组相比，BTD组达到血液学CR的时间明显更短（4.97个月对7.71个月，p = 0.010）。此外，当达到血液学反应时，BTD组以体表面积（BSA）标准化的硼替佐米累积剂量低于BCD组(10.4 vs。15.6 mg/m2, p = 0.013)。两组间肾脏和心脏反应无显著差异。然而，与BCD组相比，BTD组治疗后的蛋白尿水平显著降低（747 mg/24h vs 2928 mg/24h, p = 0.048）。结论：与BTD方案相比，BTD方案治疗肾AL淀粉样变性的血液学CR率相似，但蛋白尿的减少更明显，硼替佐米的累积剂量减少，反应时间更快。
期刊介绍：
Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.
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