![]() 1 These depositions interfere with organs’ function,2 which reduces quality of life (QOL) and shortens survival. In immunoglobulin light chain (AL) amyloidosis, clonal plasma cells in the bone marrow produce light chains that misfold and deposit in various organs. This review provides a comprehensive assessment of eligibility criteria for ASCT in AL amyloidosis, conditioning dosing, efficacy in terms of hematologic and organ response, and future areas of research. The introduction of newer agents such as bortezomib and daratumumab (Darzalex), which lead to deep responses and have good safety profiles, encourage revisiting the benefit and timing of ASCT in the modern era. ASCT in AL amyloidosis is performed only in selected patients approximately 20% of patients with AL amyloidosis are transplant eligible up front or after bortezomib (Velcade) based conditioning. TRM is a major concern in AL amyloidosis, but its incidence can be lessened by better patient selection and by patients receiving ASCT in specialized centers. These results are of limited significance due to the unexpected high transplant-related mortality (TRM) (24%). However, only 1 randomized controlled trial compared ASCT with the standard of care used at the time, which was melphalan and dexamethasone, and the results did not support the use of ASCT in AL amyloidosis. Patients who achieve a complete hematologic response following ASCT have a long overall survival. Autologous stem cell transplantation (ASCT) has been an essential part of the treatment armamentarium in light chain (AL) amyloidosis for several decades.
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