Clinical Characteristics and Outcomes of Cyclin D1–Positive AL Amyloidosis

Abstract

Abstract Objectives To demonstrate the clinical features and prognostic impact of cyclin D1 positivity in patients with amyloid light chain amyloidosis (AL). Methods We consecutively included 71 patients diagnosed with AL with cyclin D1 positivity between February 2008 and January 2022. t(11;14) was examined through interphase fluorescence in situ hybridization using bone marrow cells. Results The median age of the patients was 73 years, and 53.5% were male. The underlying diseases included symptomatic multiple myeloma, smoldering multiple myeloma, Waldenström macroglobulinemia, and monoclonal gammopathy of undetermined significance, representing 33.8%, 26.8%, 2.8%, and 36.6%, respectively. The prevalence of cyclin D1 and t(11;14) was 38.0% and 34.7%, respectively. Higher frequency of light chain paraprotein type was seen in cyclin D1–positive patients with AL than in cyclin D1–negative patients (70.4% vs 18.2%). The median overall survival (OS) of patients with AL with and without cyclin D1 expression was 18.9 months and 73.1 months, respectively (P = .019). Early death occurred in 44.4% of cyclin D1–positive patients and 31.8% of cyclin D1–negative patients. Moreover, 83.3% of cyclin D1–positive patients and 21.4% of cyclin D1–negative patients died of cardiac causes. Conclusions Cyclin D1 immunohistochemistry accurately identified patients with t(11;14). Cyclin D1–positive patients had significantly inferior OS compared with cyclin D1–negative patients.