AL Amyloidosis After Dara-CyBorD Induction Without Achieving VGPR: What Comes Next?

When first-line induction therapy for AL amyloidosis does not produce a deep enough hematologic response, a defined next-step protocol guides further management. The scenario below describes this escalation pathway and the clinical rationale behind it.

Prior Treatment — Failure Condition

Induction with daratumumab, cyclophosphamide, bortezomib, and dexamethasone (Dara-CyBorD) did not achieve a hematologic very good partial response (VGPR) — defined as reduction of the dFLC to below 40 mg/L — after four cycles of treatment. This failure to reach the required response depth triggers escalation to the next protocol.

Next-Step Approach (partial)

For transplant-eligible patients who have not reached the required depth of response, autologous stem-cell transplantation is a central element of the escalation strategy. Specific eligibility thresholds and procedural details are defined in the full protocol.

Complete regimen, eligibility criteria, and additional clinical detail are available behind the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1200/OP.22.00396
In the setting of a partial response, we give two additional cycles of treatment and plan to proceed with ASCT if a VGPR is not achieved.
If transplant-eligible, refer for auto-ASCT.

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