Amyloidosis

The use of high-dose therapy and stem cell transplant for primary amyloidosis has gained in popularity recently.

Given the dismal outcome of patients with a diagnosis of AL amyloidosis, with or without conventional-dose therapy, a number of groups have carried out trials exploring the use of high-dose therapy in this setting. It is clear that the selection of patients with amyloidosis for high-dose therapy is of the utmost importance. The extent of organ involvement prior to high-dose therapy accounts for most of the transplant-related morbidity and mortality.100101 In one trial, 43 patients were transplanted; those with two or more involved organs had a 100-day survival of 33% as compared with 81% for those with more than two organs involved. The Mayo Clinic treated 66 patients with a treatment-related mortality of 14%. Multivariate analysis revealed that serum creati-nine and number of organs involved were the key predictors of survival. The 30-month survival was 72% overall, but was <20% for patients with more than two organs involved. They have therefore pub-

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