1089P - Malnutrition at diagnosis independently predicts mortality in patients with systemic immunoglobulin light-chain amyloidosis (AL)

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Haematologic Malignancies
Presenter Riccardo Caccialanza
Authors R. Caccialanza1, G. Palladini2, C. Klersy3, E. Cereda1, C. Bonardi1, L. Quarleri1, G. Merlini2
  • 1Nutrition And Dietetics Service, Fondazione IRCCS Policlinico San Matteo, 27100 - Pavia/IT
  • 2Amyloidosis Research And Treatment Center, Biotechnology Research Laboratories, Department Of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia/IT
  • 3Biometry And Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia/IT

Abstract

Rationale

We have previously shown that malnutrition is associated with reduced survival in outpatients with immunoglobulin light-chain amyloidosis (AL). However, these findings were obtained in a mixed population of treated and untreated patients with different disease duration and in whom the Mayo Clinic cardiac staging system was not considered. The aim of this study was to investigate the prognostic role of nutritional status of AL patients at diagnosis.

Methods

One hundred and twenty eight consecutive newly diagnosed and previously untreated patients with AL were enrolled. Anthropometric, biochemical and clinical variables were measured.

Results

Prevalence of relevant unintentional weight loss (WL; ≥10% in 6 months), reduced body mass index (BMI; <22 kg/m2) and low serum prealbumin (<20 mg/dL) were 15.6%, 21.9% and 40.6%, respectively. Age (HR= 1.03 [95%CI, 1.00-1.06]), cardiac stage III (HR= 6.06 [95%CI, 3.33-11.03]), BMI < 22 (HR= 1.86 [95%CI, 1.01-3.43]) and WL ≥ 10% (HR= 1.99 [95%CI, 1.03-3.83]) were independent predictors of survival. Secondary analysis including also response to treatment (hematological and/or cardiac) confirmed these findings: BMI < 22, HR = 2.02 [95%CI, 1.10-3.70]; WL ≥ 10%, HR = 2.14 [95%CI, 1.10-4.16]. The risk for mortality was similar for severe (defined as BMI < 22 and WL ≥ 10%) and moderate (defined as BMI < 22 or WL ≥ 10%) malnutrition: severe, HR = 3.24 [95%CI, 1.78-5.90]; moderate, HR = 3.07 [95%CI, 1.31-7.23].

Conclusions

In AL patients, malnutrition at diagnosis is a common comorbidity which negatively affects the prognosis, independently from cardiac stage, which is the most powerful survival determinant. Future research should systematically consider the role of nutritional status on clinical outcomes in AL and nutritional intervention trials are now urgently warranted.

Disclosure

All authors have declared no conflicts of interest.