Abstract
As cardiac involvement is the most important prognostic marker in light-chain amyloidosis (AL), revised Mayo staging for AL incorporated N-terminal pro-brain natriuretic peptide (NTproBNP) and troponin T (TnT). However, prognostic value of novel biomarkers, such as soluble suppression of tumorigenicity 2 (sST2), growth differentiation factor 15 (GDF15), or osteopontin (OPN) is unknown in AL amyloidosis. We aimed to investigate additive predictive effects of novel biomarkers for overall mortality rates of AL amyloidosis patients. Levels of sST2, GDF15, and OPN were quantified at diagnosis in a total of 73 AL amyloidosis patients at Samsung Medical Center from 2010 to 2016. The median follow-up duration of the censored cases was 18.0 (12.4–28.1) months. A total of 25 deaths occurred during the follow-up period. Two novel biomarkers, sST2 and GDF-15 showed satisfactory predictive performances for both one-year and overall survival from ROC analysis. Best cut-off values for predicting one-year mortality were selected. Elevated sST2 and GDF-15 levels showed significant incremental prognostic values in addition to NT-ProBNP and TnT for overall mortality. Patients were assigned 1 point for elevated sST2 or GDF-15. The mean values of NT-proBNP, TnT, mean LV wall thickness, and septal e′ velocity differed significantly according to the scores. Patients with higher scores showed significantly worse prognosis even in patients with advanced revised Mayo staging. Two novel biomarkers, sST2 and GDF-15, showed satisfactory prognostic value for overall survival of AL amyloidosis patients. Furthermore, sST2 and GDF-15 showed additive incremental values over conventional biomarkers and further discriminated prognosis of patients in advanced stages.
Highlights
Cardiac involvement is the most important prognostic marker in light-chain amyloidosis (AL)
We evaluated prognostic performances of novel biomarkers in patients with AL amyloidosis
The result obtained in this cohort of patients show that (1) the novel biomarkers suppression of tumorigenicity 2 (sST2) and GDF-15 show satisfactory prognostic values for overall survival in patients with AL amyloidosis, (2) sST2 and GDF-15 had incremental prognostic values over the conventional biomarkers NT-proBNP and troponin T (TnT), and (3) sST2 and GDF-15 further discriminated prognosis of patients at advanced revised Mayo stages
Summary
Cardiac involvement is the most important prognostic marker in light-chain amyloidosis (AL). Recent advances in chemotherapy regimens for AL amyloidosis have improved overall survival, even in patients with cardiac involvement[2,3]. Previous studies have showed that cardiac amyloid load is significantly associated with prognosis of AL amyloid patients, suggesting different prognosis according to degree of cardiac involvement[4]. More detailed risk stratification of AL amyloidosis patients with cardiac involvement is needed. Considering the complex pathophysiology of cardiac involvement in AL amyloidosis, a simple combination of NT-proBNP and TnT may not provide sufficient prognostic information. Novel biomarkers with different pathophysiological targets would contribute to detailed risk stratification, which could facilitate development of risk-adapted therapies in AL amyloidosis patients, especially those with cardiac involvement. The prognostic performance of soluble suppression of tumorigenicity 2 (sST2), growth differentiation www.nature.com/scientificreports/
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