Cyclophosphamide-bortezomib-dexamethasone (CyBorD) produces rapid and complete hematologic response in patients with AL amyloidosis

Blood. 2012 May 10;119(19):4391-4. doi: 10.1182/blood-2011-11-390930. Epub 2012 Feb 13.

Abstract

Cyclophosphamide, bortezomib, and dexamethasone (CyBorD) is highly effective in multiple myeloma. We treated patients with light chain amyloidosis (AL) before stem cell transplantation (ASCT), instead of ASCT in ineligible patients or as salvage. Treatment was a combination of bortezomib (1.5 mg/m2 weekly), cyclophosphamide (300 mg/m2 orally weekly), and dexamethasone (40 mg weekly). Seventeen patients received 2 to 6 cycles of CyBorD. Ten (58%) had symptomatic cardiac involvement, and 14 (82%) had 2 or more organs involved. Response occurred in 16 (94%), with 71% achieving complete hematologic response and 24% a partial response. Time to response was 2 months. Three patients originally not eligible for ASCT became eligible. CyBorD produces rapid and complete hematologic responses in the majority of patients with AL regardless of previous treatment or ASCT candidacy. It is well tolerated with few side effects. CyBorD warrants continued investigation as treatment for AL.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amyloid / metabolism
  • Amyloidosis / drug therapy*
  • Amyloidosis / metabolism
  • Amyloidosis / mortality
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Boronic Acids / administration & dosage*
  • Boronic Acids / adverse effects
  • Bortezomib
  • Cohort Studies
  • Cyclophosphamide / administration & dosage*
  • Cyclophosphamide / adverse effects
  • Cytogenetic Analysis
  • Dexamethasone / administration & dosage*
  • Dexamethasone / adverse effects
  • Humans
  • Kidney / drug effects
  • Kidney / metabolism
  • Pyrazines / administration & dosage*
  • Pyrazines / adverse effects
  • Remission Induction
  • Retrospective Studies
  • Survival Analysis
  • Time Factors

Substances

  • Amyloid
  • Boronic Acids
  • Pyrazines
  • Bortezomib
  • Dexamethasone
  • Cyclophosphamide