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

• Published in: Blood Vol. 119; no. 19; pp. 4391 - 4394
• Main Authors: Mikhael, Joseph R., Schuster, Steven R., Jimenez-Zepeda, Victor H., Bello, Nancy, Spong, Jacy, Reeder, Craig B., Stewart, A. Keith, Bergsagel, P. Leif, Fonseca, Rafael
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 10-05-2012; Americain Society of Hematology; American Society of Hematology
• Subjects: Amyloid - metabolism; Amyloidosis - drug therapy; Amyloidosis - metabolism; Amyloidosis - mortality; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Boronic Acids - administration & dosage; Boronic Acids - adverse effects; Bortezomib; Brief Report; Clinical Trials and Observations; Cohort Studies; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cytogenetic Analysis; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Hematologic and hematopoietic diseases; Humans; Kidney - drug effects; Kidney - metabolism; Lymphoid Neoplasia; Medical sciences; Pyrazines - administration & dosage; Pyrazines - adverse effects; Remission Induction; Retrospective Studies; Survival Analysis; Time Factors; Antineoplastic agent; Human; Corticosteroid; AL amyloidosis; Bortezomib; Dexamethasone; Hematology; Steroid hormone; Alkylating agent; Oxazaphosphinane derivatives; Cyclophosphamide; Analog; Proteasome inhibitor; Nitrogen mustard; Dipeptides
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2011-11-390930

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.