Objectives:Daratumumab in combination with cyclophosphamide, bortezomib (Dara-VCd), and dexamethasone is the currently standard frontline therapy for newly-diagnosed AL amyloidosis. However, up to one-fourth of patients do not achieve a deep response (≥VGPR) with D-VCd induction. ASCT can upgrade hematologic responses in patients with suboptimal response to Dara-VCd. This study will assess the efficacy and safety of Dara-based induction therapy followed with ASCT consolidation in AL amyloidosis.
Methods:This was a retrospective analysis comparing VD induction followed by ASCT (VD+ASCT) with Dara-based induction followed by ASCT (Dara-based +ASCT) in the treatment of patients with newly diagnosed AL amyloidosis. The median induction cycles were 4.
Results:A total of 22 patients with AL amyloidosis were included in the analysis between 03/2011 and 12/2023 in our center. Among these patients,16 patients were in VD+ASCT group and 6 patients were in Dara-based +ASCT group. The median age at diagnosis was 52.5(46.3-57) in VD+ASCT group and 59(54.5-62.3) in Dara-based +ASCT group. At diagnosis,73.3% (11/15) had Mayo 2004 stage I in VD+ASCT group, with 66.7% (4/6) having Mayo 04 stage I in Dara-based +ASCT group. There were 100% kidney involvement in both groups. At the end of induction therapy, the rate of hematologic CR was 37.5% (6/16) in VD+ASCT,66.7% in Dara-based +ASCT (P=0.348). Five of the sixteen patients (31.3%) with renal involvement achieved a renal response in VD+ASCT group, with 3 of the six patients (50%) in Dara-based +ASCT group(P=0.624) after induction therapy. The best hematologic response after ASCT was CR in 9(56.3%) patients treated with VD+ASCT, in 5(83.3%) patients with Dara-based +ASCT. Six of the sixteen patients (37.5%) achieved a renal response in VD+ASCT group, with 5 of the six patients (83.3%) in Dara-based +ASCT group after induction therapy. TRM in two groups were 0.
Conclusions:Dara-based regimen followed with ASCT is safe and can upgrade hematologic responses in carefully selected patients with newly-diagnosed AL amyloidosis.
No relevant conflicts of interest to declare.
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