Treatment patterns for AL amyloidosis after frontline daratumumab, bortezomib, cyclophosphamide, and dexamethasone treatment failures
Saurabh Zanwar, Morie A. Gertz, Eli Muchtar, Francis K. Buadi, Taxiarchis Kourelis, Wilson I. Gonsalves, Ronald S. Go, Suzanne R. Hayman, Prashant Kapoor, Moritz Binder, Joselle Cook, David Dingli, Nelson Leung, Yi Lin, Rahma Warsame, Amie Fonder, Miriam Hobbs, Yi L. Hwa, Robert A. Kyle, S. Vincent Rajkumar, Shaji Kumar, Angela Dispenzieri
Abstract
The immediate goal for therapy in patients with systemic immunoglobulin light chain amyloidosis (AL) is to swiftly achieve at least a hematologic very good partial response (VGPR), given the consistently improved organ responses and survival with achievement of deep hematologic responses [ 1 , 2 , 3 ]. The phase III ANDROMEDA trial demonstrated that the addition of daratumumab to bortezomib, cyclophosphamide, and dexamethasone (D-VCd) resulted in significantly higher hematologic CR (53%) and VGPR rates (78%) compared to VCd in previously untreated patients [ 4 ]. These outstanding response rates have led to D-VCd being the currently accepted frontline therapy for AL amyloidosis. However, up to one-fourth of patients do not achieve a deep response (≥VGPR) with D-VCd induction and may need subsequent treatment to improve the response depth [ 4 ]. Data guiding the selection of subsequent treatment in these patients are limited, and here we report on the patterns of treatment failure and subsequent therapies in this cohort of patients.