COMy 2020 | Management of AL amyloidosis: what’s new?

Giampaolo Merlini, MD, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy, discusses recent advances in the management of light-chain (AL) amyloidosis. The Phase III trial, TOURMALINE-AL1 (NCT01659658), had to be discontinued for not reaching the first of two primary endpoints. Despite discontinuation, there were no safety concerns relating to the drug ixazomib and it is still a promising potential treatment for light chain amyloidosis. In the frontline setting, the Phase III trial (NCT01277016) with newly diagnosed AL amyloidosis evaluated oral melphalan and dexamethasone with or without bortezomib. The addition of bortezomib improved progression-free and overall survival. Furthermore, the results from the Phase III ANDROMEDA study (NCT03201965) indicate that the use of daratumumab in combination with cyclophosphamide, bortezomib and dexamethasone (CyBorD) produces a complete and improved organ response in AL amyloidosis. Therefore, daratumumab plus CyBorD could become the new standard of care in frontline patients. Additionally, Prof. Merlini discusses how the current criteria for response to treatment needs to be changed in light of new research and needs to consider the impact of measurable residual disease (MRD). This interview took place during the Controversies in Multiple Myeloma (COMy) 2020 Virtual World Congress.