Impact of academic center–based care on clinical outcomes in light chain amyloidosis.

Abstract

e13798 Background: Light chain (AL) amyloidosis requires coordinated hematologic and organ-specific care, often delivered through multidisciplinary teams. However, real-world data comparing outcomes between academic and non-academic centers are limited. We compared outcomes in patients with AL amyloidosis managed at academic versus non-academic centers using a global real-world database. Methods: We performed a retrospective cohort study using the TriNetX Network. Adult patients with AL amyloidosis without history of neoplasms were identified and categorized by care at academic or non-academic centers with index as the diagnosis of AL amyloidosis, and outcomes assessed one day after the index. Propensity score matching was performed using demographic and clinical characteristics, including conditions associated with congestive heart failure (CHF) and requiring steroid therapy independent of amyloidosis. Outcomes included hospitalization, steroid use, chronic kidney disease (CKD), dialysis, CHF, CHF exacerbation, and death. Patients with outcomes prior to the time window were excluded. Results: After propensity score matching, 391 patients were included in each cohort, which were balanced for age, race and comorbidities. Median follow-up was 414 and 360 days, respectively, for the academic cohort and non-academic cohort. Hospitalization occurred in 10.4% of Academic vs 23.4% of Non-academic patients (risk difference -0.130; 95% CI -0.198 to -0.061, OR 0.38, 0.229-0.629), dialysis in 3.7% vs 8.7% (risk difference -0.050; 95% CI -0.085 to -0.015, OR 0.405, 0.212-0.772) and CHF exacerbation in 5.2% vs 9.4% (risk difference -0.043; 95% CI -0.084 to -0.001, OR 0.523, 0.279-0.98). No significant differences were observed for steroid use, CKD, or chronic CHF (Risk difference, p 0.6, 0.66 and 0.9 respectively). There was no significant difference in mortality between the two groups, HR 0.825 (0.587-1.159). 153 vs 23 patients received daratumumab in the academic vs non-academic groups. Conclusions: In this large real-world analysis, care at academic centers was associated with lower rates of hospitalization, dialysis, and CHF exacerbations, despite similar baseline prevalence of CKD and CHF. These findings suggest acute decompensation and progression markers may be more sensitive to care-related differences rather than baseline comorbidity burden. Further studies are needed to identify drivers of these differences and inform strategies to optimize care. Baseline characteristics after matching. Characteristic Academic centers Non-academic centers Age at Index 64.2 +/- 13.0 64.5 +/- 12.7 Female 153 (39.1%) 161 (41.2%) Male 238 (60.9%) 230 (58.8%) Black or African American 99 (25.3%) 88 (22.5%) White 229 (58.6%) 229 (58.6%) Hispanic or Latino 26 (6.6%) 35 (9.0%) Asian 33 (8.4%) 30 (7.7%) Atherosclerotic heart disease 72 (18.4%) 69 (17.6%) Chronic obstructive pulmonary disease 38 (9.7%) 29 (7.4%)