The following is a summary of “Graded Cardiac Response Criteria for Patients With Systemic Light Chain Amyloidosis,” published in the March 2023 issue of Oncology by Muchtar, et al.
Prognostic in light chain amyloidosis is binary cardiac response assessment using cardiac biomarkers. Prior research revealed that employing the N-terminal prohormone of the brain natriuretic peptide, four-level cardiac responses, could improve prognostic prediction. Therefore, using the N-terminal prohormone of brain natriuretic peptide/brain natriuretic peptide, researchers, for a study, sought to validate graded cardiac response criteria.
The retrospective, multicenter study included patients with light chain amyloidosis who were evaluable for cardiac response and who at least experienced a hematologic partial response (PR). Based on natriuretic peptide response depth, four response criteria were examined: cardiac complete response (CarCR), cardiac very good partial response (CarVGPR), cardiac PR (CarPR), and cardiac no response (CarNR) (CarNR). The reaction was rated as the best response at predetermined intervals (6, 12, and 24 months from therapy initiation). Overall survival was the main outcome of the study.
There were 651 patients in total. The highest rates of CarCR, CarVGPR, CarPR, and CarNR were attained by 16%, 26.4%, 22.9%, and 34.7% of patients, respectively. Individuals in cardiac stage II were more likely than those in cardiac stages IIIA and IIIB to attain CarCR (22% v 13.5% v 3.2%; P < .001). Longer survival rates were linked to deeper cardiac responses (5-year overall survival 93%, 79%, 65%, and 33% for CarCR, CarVGPR, CarPR, and CarNR, respectively; P < .001). Deeper cardiac responses provided an independent survival advantage, confirmed by fixed time-point studies and time-varying variables Cox regression analysis to reduce survivorship bias. A four-level response outperformed a two-level response after just a year of therapy.
Compared to the conventional binary response approach, graded cardiac response criteria provided a better assessment of cardiac improvement. The study reiterated the significance of early diagnosis, which raised the possibility of profound cardiac reactions.
Reference: ascopubs.org/doi/full/10.1200/JCO.22.00643