Acquired
factor X deficiency and associated haemorrhage can be consequences of
immunoglobulin light chain amyloidosis. There are limited data on the safety and efficacy of autologous stem cell transplant (ASCT) on
factor X deficiency. We retrospectively reviewed
immunoglobulin light chain amyloidosis patients with
factor X levels below 50%, not on chronic anticoagulation who underwent ASCT at the Mayo Clinic, Rochester, Minnesota, USA, between April 1995 and December 2011. Twenty-seven of 358 patients (7.5%) met study criteria. Median pre-ASCT
factor X was 36% (range: 2-49%). The most frequent and severe
bleeding complications occurred in patients with
factor X levels below 10%. Peri-procedural prophylaxis included activated recombinant
factor VII, fresh frozen plasma and
platelet transfusions. Steady-state post-ASCT
factor X levels were determined in 12 patients. Post-ASCT
factor X levels increased in 100% of patients, with median
factor X improvement of +32% (range: +8 to +92%). About 46.2% of patients were no longer
factor X deficient after ASCT. The degree of improvement in
factor X levels was correlated with an improvement in markers of renal involvement by
amyloid. Improvement in
factor X correlated with an improvement in the degree of total
serum protein (ρ = 0.54; P = 0.04) and
proteinuria (ρ = -0.54; P = 0.04). Our findings support the decision to offer ASCT to
factor X-deficient patients as both appropriate and efficacious.