In newly diagnosed AL amyloidosis, fit patients who elect disease-directed therapy require a structured induction approach with clearly defined response criteria. The goal is to achieve rapid, deep hematologic response early in the treatment course.
The hematologic target is a very good partial response (VGPR) or better, defined as a reduction of the difference between involved and uninvolved free light chains (dFLC) to less than 40 mg/L. This is assessed after the initial induction cycles.
Current evidence supports a four-drug anti-plasma cell combination as induction, with hematologic response assessed after the first several cycles. For patients reaching the depth-of-response target, the protocol transitions to a defined maintenance phase. The complete regimen, sequencing, and criteria for each transition are detailed in the full structured protocol.
DOI: 10.1200/OP.22.00396
In fit patients who elect to pursue disease-directed therapy, a four-drug combination of anti-plasma cell agents is currently used to treat patients with newly diagnosed AL amyloidosis including daratumumab, cyclophosphamide, bortezomib, and dexamethasone (CyBorD).
In patients who achieve a hematologic very good partial response (VGPR) or better, induction is completed followed by daratumumab maintenance for a total of 2 years.
Complete 6 cycles of Dara + CyBorD, followed by single-agent dara for a total of 2 years (per ANDROMEDA trial).
Assess hematologic response after four cycles. Reduction of the dFLC to < 40 mg/L.
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