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Daratumumab yields rapid and deep hematologic responses in patients with heavily pretreated AL amyloidosis

Gregory P. Kaufman, Stanley L. Schrier, Richard A. Lafayette, Sally Arai, Ronald M. Witteles and Michaela Liedtke

Key points

  • Daratumumab is highy active in AL amyloidosis

Abstract

The majority of patients with immunoglobulin light chain amyloidosis (AL) fail to achieve a complete response (CR) to standard light chain suppressive chemotherapy, and almost all patients eventually experience hematologic relapse and progression of organ involvement; additional well tolerated treatment options are therefore needed. We present our retrospective experience of 25 consecutive previously treated AL patients who received daratumumab, a CD38-directed monoclonal antibody approved for the treatment of multiple myeloma. Daratumumab was administered at 16mg/kg weekly for 8 weeks, then every 2 weeks for 8 doses, then every 4 weeks. Patients had received a median of 3 prior lines of therapy, with a previous hematologic CR in only 5 patients. The overall hematologic response rate to daratumumab was 76%, including CR in 36% and very good partial response in 24%. Median time to response was one month. Therapy was well tolerated, even among the 78% of patients with cardiac AL involvement. Grade 1-2 infusion reactions occurred in 15 patients, but no grade 3 or 4 reactions were observed. Daratumumab is a highly effective agent that produced rapid and deep hematologic responses without unexpected toxicity in our cohort of heavily pretreated AL patients.

  • Submitted January 23, 2017.
  • Accepted May 16, 2017.