Patient outcomes in light chain (AL) amyloidosis: The clock is ticking from symptoms to diagnosis.

Amanda Schulman, Lawreen H Connors, Janice Weinberg, Lisa M Mendelson, Tracy Joshi, Anthony C Shelton, Vaishali Sanchorawala
Author Information
  1. Amanda Schulman: Amyloidosis Center, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA. ORCID
  2. Lawreen H Connors: Amyloidosis Center, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA. ORCID
  3. Janice Weinberg: Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA. ORCID
  4. Lisa M Mendelson: Amyloidosis Center, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA. ORCID
  5. Tracy Joshi: Amyloidosis Center, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
  6. Anthony C Shelton: Amyloidosis Center, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA. ORCID
  7. Vaishali Sanchorawala: Amyloidosis Center, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA. ORCID

Abstract

INTRODUCTION: Symptomology of AL Amyloidosis can be vague, with a broad range of manifestations and potential etiologies. We sought to determine whether time from initial patient-reported symptom onset to diagnosis was associated with survival.
METHODS: The Boston University Amyloidosis patient Database was queried for patients with AL Amyloidosis who presented to the Center for initial evaluation from 2010 to 2015.
RESULTS: A total of 324 patients with AL Amyloidosis were evaluated for initial evaluation. The median time to diagnosis from initial symptom onset was 7.1 months (range, 0-61). At data cutoff, 60.2% (n = 195) of patients were alive; of those, the majority were diagnosed <6 months from initial symptoms (52.3%, n = 102). In contrast, time to diagnosis from symptom onset was >6 months in 63.6% (n = 82) of patients who did not survive at the time of data cutoff (P = .0005). Survival analysis of time from diagnosis to death or data cutoff stratified by time from patient-reported symptom onset to diagnosis (<6, 6-12, and >12 months) showed significant differences among groups (P = .001). Additionally, multivariable regression demonstrated that an increase in time from self-reported symptom onset to diagnosis was significantly associated with an increased risk of death (HR = 1.02, 95% CI = 1.01-1.04, P = .002).
CONCLUSION: These results support the importance of early diagnosis for patients with AL Amyloidosis.

Keywords

References

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Grants

  1. /The Amyloidosis Center database and repository are supported by Amyloid Research Fund of Boston University School of Medicine

MeSH Term

Databases, Factual
Disease Management
Disease Susceptibility
Early Diagnosis
Health Care Surveys
Humans
Immunoglobulin Light-chain Amyloidosis
Patient Outcome Assessment
Prognosis

Word Cloud

Created with Highcharts 10.0.0diagnosistimeALamyloidosisinitialsymptomonsetpatientsdatacutoffsymptomsP = rangepatient-reportedassociatedsurvivalPatientevaluationdeathINTRODUCTION:SymptomologycanvaguebroadmanifestationspotentialetiologiessoughtdeterminewhetherMETHODS:BostonUniversityAmyloidosisDatabasequeriedpresentedCenter20102015RESULTS:total324evaluatedmedian71 months0-61602%n = 195alivemajoritydiagnosed<6 months523%n = 102contrast>6 months636%n = 82survive0005Survivalanalysisstratified<66-12>12 monthsshowedsignificantdifferencesamonggroups001Additionallymultivariableregressiondemonstratedincreaseself-reportedsignificantlyincreasedriskHR = 10295%CI = 101-104002CONCLUSION:resultssupportimportanceearlyoutcomeslightchainamyloidosis:clockticking

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