SOHO 2020 | How to treat AL amyloidosis in 2020?

In 2020, we have a lot more options for AL amyloidosis, and I would like to start with the most exciting drug and clinical trial. So far, we have treated AL amyloidosis with CyBorD, a combination of cyclophosphamide, bortezomib, and dexamethasone. But recent studies have shown that daratumumab is very potent for the treatment of AL amyloidosis. Daratumumab as a single agent, in retrospective analysis, has been shown that it induces a very fast and very deep remission. So patients had a normalization of their free light chains within two weeks.

So based on those exciting, I would say retrospective, results there was the ANDROMEDA study, it launched, and that is a randomized trial, which compared our old standard of care, CyBorD, vs the novel, I would say, or the new treatment, which is CyBorD plus daratumuab. Around 380 patients were randomized. The study was completed, the accrual was completed at EHA, new data were presented. The final data of the run-in safety trial, which included 28 patients, were published in Blood and they showed an excellent response rate.

It’s too early for overall survival. The response rate of the combination was over 82% VGPR and 54% of complete remission. The trial also resulted in high organ response rates, so in terms of renal response rate in this trial, 83% of the patients had improvement of their renal function and in terms of cardiac response, 53 had improvement of their cardiac function. So very encouraging data. So I think if possible in 2020, if the insurance allows this, and I know there are countries specific, problems but if you have the opportunity to treat patients with CyBorD in combination with daratumuab, I think this is the best option to start with newly diagnosed patients. Also in terms of relapse patients for patients who had not had daratumuab, I think it should be included in regimens for relapse patients.