Background: Patients with
amyloid light-chain (
AL) amyloidosis who have advanced cardiac damage are at risk of premature mortality. Currently,
bortezomib is the mainstay in the treatment of
AL amyloidosis, but the benefits of
bortezomib in patients with ultra-high-risk (2004 Mayo stage IIIb or 2012 Mayo stage IV)
AL amyloidosis have not been proved definitively. Methods: We performed a retrospective analysis of patients newly diagnosed with ultra-high-risk
AL amyloidosis who received a
bortezomib-based regimen or supportive treatment. We aimed to establish the effects of
bortezomib on early mortality and long-term outcomes in this high-risk population. Results: Patients receiving
bortezomib-containing
chemotherapy (n = 62) and patients receiving no
chemotherapy (n = 24) were included. Median overall survival (OS) was 30 months in the
bortezomib group and 2 months in the control group (p < .001), and median progression-free survival (PFS) was 15.8 months (
bortezomib) and 2 months (control; p < .001). The early-death rate (within 6 months of treatment) was 32.3% (
bortezomib) and 66.7% (control; p < .001). In a landmark analysis assessing outcomes in patients surviving beyond 6 months, the 2-year OS and PFS in the
bortezomib group were 77.3% and 65.8%, respectively. Conclusions:
Bortezomib-based regimens can help to reduce early mortality and improve long-term survival in patients with ultra-high-risk
AL amyloidosis.