Malnutrition at diagnosis predicts mortality in patients with systemic immunoglobulin light-chain amyloidosis independently of cardiac stage and response to treatment

Riccardo Caccialanza, Giovanni Palladini, Catherine Klersy, Emanuele Cereda, Chiara Bonardi, Barbara Cameletti, Lara Quarleri, Elisabetta Montagna, Andrea Foli, Paolo Milani, Francesca Lavatelli, Carlo Marena, Giampaolo Merlini

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Abstract

Background: Nutrition status was shown to be a prognostic factor in patients with immunoglobulin light-chain amyloidosis (AL). However, malnutrition was associated with cardiac involvement, thus suggesting potential interactions. This study aim was to clarify the association among nutrition status, cardiac stage, and mortality in AL. Methods: One hundred twenty-eight consecutive newly diagnosed, treatment-naïve patients with histologically confirmed AL were enrolled. Anthropometric, biochemical, and clinical variables were assessed. Results: At multivariable Cox proportional hazard analysis, body mass index (BMI) <22 kg/m2 (HR = 1.98, 95% CI = 1.09-3.56) and unintentional 6-month weight loss (WL) ≥ 10% (HR = 1.94, 95% CI = 1.00-3.74) resulted in independent predictors of survival after controlling for hematologic response to treatment (HR = 0.27, 95% CI = 0.14-0.53) and cardiac stage (Mayo Clinic stage III, HR = 4.42, 95% CI = 2.61-7.51). There was no effect modification of malnutrition on mortality by cardiac stage (P for interaction =.27). Moderate and severe malnutrition (prevalence: 21.9% and 7.8%, respectively) similarly increased the risk of death (HR = 3.09, 95% CI = 1.75-5.46; 2.88, 95% CI = 1.23-6.72, respectively). Conclusions: In AL, malnutrition at diagnosis is a frequent comorbidity that affects the prognosis independently of hematologic response to treatment and cardiac stage. Nutrition status should be systematically considered in future intervention trials in AL. Nutrition support trials are warranted.

Original languageEnglish
Pages (from-to)891-894
Number of pages4
JournalJournal of Parenteral and Enteral Nutrition
Volume38
Issue number7
DOIs
Publication statusPublished - Sep 19 2014

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Immunoglobulin Light Chains
Amyloidosis
Malnutrition
Nutritional Status
Mortality
Therapeutics
Comorbidity
Weight Loss
Body Mass Index
Survival

Keywords

  • AL
  • amyloidosis
  • cardiac stage
  • malnutrition
  • survival
  • treatment response

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Medicine(all)

Cite this

@article{c469bbc1472a46cf82d8618ef45b513d,
title = "Malnutrition at diagnosis predicts mortality in patients with systemic immunoglobulin light-chain amyloidosis independently of cardiac stage and response to treatment",
abstract = "Background: Nutrition status was shown to be a prognostic factor in patients with immunoglobulin light-chain amyloidosis (AL). However, malnutrition was associated with cardiac involvement, thus suggesting potential interactions. This study aim was to clarify the association among nutrition status, cardiac stage, and mortality in AL. Methods: One hundred twenty-eight consecutive newly diagnosed, treatment-na{\"i}ve patients with histologically confirmed AL were enrolled. Anthropometric, biochemical, and clinical variables were assessed. Results: At multivariable Cox proportional hazard analysis, body mass index (BMI) <22 kg/m2 (HR = 1.98, 95{\%} CI = 1.09-3.56) and unintentional 6-month weight loss (WL) ≥ 10{\%} (HR = 1.94, 95{\%} CI = 1.00-3.74) resulted in independent predictors of survival after controlling for hematologic response to treatment (HR = 0.27, 95{\%} CI = 0.14-0.53) and cardiac stage (Mayo Clinic stage III, HR = 4.42, 95{\%} CI = 2.61-7.51). There was no effect modification of malnutrition on mortality by cardiac stage (P for interaction =.27). Moderate and severe malnutrition (prevalence: 21.9{\%} and 7.8{\%}, respectively) similarly increased the risk of death (HR = 3.09, 95{\%} CI = 1.75-5.46; 2.88, 95{\%} CI = 1.23-6.72, respectively). Conclusions: In AL, malnutrition at diagnosis is a frequent comorbidity that affects the prognosis independently of hematologic response to treatment and cardiac stage. Nutrition status should be systematically considered in future intervention trials in AL. Nutrition support trials are warranted.",
keywords = "AL, amyloidosis, cardiac stage, malnutrition, survival, treatment response",
author = "Riccardo Caccialanza and Giovanni Palladini and Catherine Klersy and Emanuele Cereda and Chiara Bonardi and Barbara Cameletti and Lara Quarleri and Elisabetta Montagna and Andrea Foli and Paolo Milani and Francesca Lavatelli and Carlo Marena and Giampaolo Merlini",
year = "2014",
month = "9",
day = "19",
doi = "10.1177/0148607113501328",
language = "English",
volume = "38",
pages = "891--894",
journal = "Journal of Parenteral and Enteral Nutrition",
issn = "0148-6071",
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TY - JOUR

T1 - Malnutrition at diagnosis predicts mortality in patients with systemic immunoglobulin light-chain amyloidosis independently of cardiac stage and response to treatment

AU - Caccialanza, Riccardo

AU - Palladini, Giovanni

AU - Klersy, Catherine

AU - Cereda, Emanuele

AU - Bonardi, Chiara

AU - Cameletti, Barbara

AU - Quarleri, Lara

AU - Montagna, Elisabetta

AU - Foli, Andrea

AU - Milani, Paolo

AU - Lavatelli, Francesca

AU - Marena, Carlo

AU - Merlini, Giampaolo

PY - 2014/9/19

Y1 - 2014/9/19

N2 - Background: Nutrition status was shown to be a prognostic factor in patients with immunoglobulin light-chain amyloidosis (AL). However, malnutrition was associated with cardiac involvement, thus suggesting potential interactions. This study aim was to clarify the association among nutrition status, cardiac stage, and mortality in AL. Methods: One hundred twenty-eight consecutive newly diagnosed, treatment-naïve patients with histologically confirmed AL were enrolled. Anthropometric, biochemical, and clinical variables were assessed. Results: At multivariable Cox proportional hazard analysis, body mass index (BMI) <22 kg/m2 (HR = 1.98, 95% CI = 1.09-3.56) and unintentional 6-month weight loss (WL) ≥ 10% (HR = 1.94, 95% CI = 1.00-3.74) resulted in independent predictors of survival after controlling for hematologic response to treatment (HR = 0.27, 95% CI = 0.14-0.53) and cardiac stage (Mayo Clinic stage III, HR = 4.42, 95% CI = 2.61-7.51). There was no effect modification of malnutrition on mortality by cardiac stage (P for interaction =.27). Moderate and severe malnutrition (prevalence: 21.9% and 7.8%, respectively) similarly increased the risk of death (HR = 3.09, 95% CI = 1.75-5.46; 2.88, 95% CI = 1.23-6.72, respectively). Conclusions: In AL, malnutrition at diagnosis is a frequent comorbidity that affects the prognosis independently of hematologic response to treatment and cardiac stage. Nutrition status should be systematically considered in future intervention trials in AL. Nutrition support trials are warranted.

AB - Background: Nutrition status was shown to be a prognostic factor in patients with immunoglobulin light-chain amyloidosis (AL). However, malnutrition was associated with cardiac involvement, thus suggesting potential interactions. This study aim was to clarify the association among nutrition status, cardiac stage, and mortality in AL. Methods: One hundred twenty-eight consecutive newly diagnosed, treatment-naïve patients with histologically confirmed AL were enrolled. Anthropometric, biochemical, and clinical variables were assessed. Results: At multivariable Cox proportional hazard analysis, body mass index (BMI) <22 kg/m2 (HR = 1.98, 95% CI = 1.09-3.56) and unintentional 6-month weight loss (WL) ≥ 10% (HR = 1.94, 95% CI = 1.00-3.74) resulted in independent predictors of survival after controlling for hematologic response to treatment (HR = 0.27, 95% CI = 0.14-0.53) and cardiac stage (Mayo Clinic stage III, HR = 4.42, 95% CI = 2.61-7.51). There was no effect modification of malnutrition on mortality by cardiac stage (P for interaction =.27). Moderate and severe malnutrition (prevalence: 21.9% and 7.8%, respectively) similarly increased the risk of death (HR = 3.09, 95% CI = 1.75-5.46; 2.88, 95% CI = 1.23-6.72, respectively). Conclusions: In AL, malnutrition at diagnosis is a frequent comorbidity that affects the prognosis independently of hematologic response to treatment and cardiac stage. Nutrition status should be systematically considered in future intervention trials in AL. Nutrition support trials are warranted.

KW - AL

KW - amyloidosis

KW - cardiac stage

KW - malnutrition

KW - survival

KW - treatment response

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U2 - 10.1177/0148607113501328

DO - 10.1177/0148607113501328

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