Key result
Baseline 6MWT ≥300m predicts ~197% better overall survival versus <300m in newly diagnosed AL amyloidosis.
Why the study?
Organ response in AL amyloidosis is based on surrogate markers, creating a need for an objective functional test such as the 6MWT to capture overall clinical improvement.
Does the 6-minute walk test (6MWT) distance at baseline and its change post-chemotherapy predict overall survival in patients with newly diagnosed AL amyloidosis?
Observational (n=799)
No
Does the 6-minute walk test (6MWT) distance at baseline and its change post-chemotherapy predict overall survival in patients with newly diagnosed AL amyloidosis?
The 6-minute walk test is a strong, independent prognostic marker in AL amyloidosis, where a baseline distance ≥300m and a post-treatment improvement ≥33m predict significantly better overall survival.
Answers are grounded in this paper and cite their sources.
Supports 6MWT for prognostication in AL amyloidosis; leaves open prospective validation before guiding therapy.
OBJECTIVES: In AL amyloidosis, organ response assessment is based on surrogates (eg, cardiac biomarkers). An objective functional test, such as the 6 min walk test (6MWT), capturing overall clinical improvement, is required. We aimed to evaluate the prognostic impact of the 6MWT at baseline and change following chemotherapy. METHODS: This study evaluated the outcomes of patients who enrolled in a prospective observational study at the UK National Amyloidosis Centre (2012-2017). Patients underwent comprehensive assessments inclusive of blood testing, echocardiogram and 6MWT at baseline and annually thereafter. RESULTS: In total, 799 patients were included within the study. Median baseline 6 min walk distance (6MWD) was 362 m (IQR: 231 m). 6MWD progressively decreased with worsening cardiac disease stage (458 m, 404 m, 331 m and 168 m for cardiac Mayo stages I, II, IIIa and IIIb, respectively (p<0.0001)). In patients with a baseline 6MWT of ≥350 m, the median overall survival was not reached (vs 30.0 (95% CI 23.2 to 36.8) months if <350 m and 5.0 (95% CI 2.8 to 7.2) months if unable to attempt 6MWT (p<0.0001). Following chemotherapy, only patients in a complete haematological response improved their 6MWD by 12 months (p=0.001). Improvement in 6MWD prolonged survival in patients with cardiac amyloidosis (p=0.005). CONCLUSION: The 6MWT is prognostic in AL amyloidosis. A baseline distance of ≥350 m independently predicts better survival. These data suggest that 6MWT has utility in AL amyloidosis for baseline prognosis and assessing response.
No takes yet. Share an insight, caveat, or question.
Cohen et al. (2022) conducted an observational in Systemic AL amyloidosis (n=799). 6-minute walk test (6MWT) ≥300m vs. 6MWT <300m was evaluated on Overall survival (HR 2.97, 95% CI 2.38-3.72, p=<0.0001). A baseline 6-minute walk test distance of ≥300m independently predicted better overall survival compared to <300m in patients with newly diagnosed AL amyloidosis (HR 2.97).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: