Daratumumab-Based Treatment for Immunoglobulin Light-Chain Amyloidosis

ANDROMEDA Trial Investigators, E. Kastritis, G. Palladini, M. C. Minnema, A. D. Wechalekar, A. Jaccard, H. C. Lee, [No Value] Sanchorawala, S. Gibbs, P. Mollee, C. P. Venner, J. Lu, S. Schonland, M. E. Gatt, K. Suzuki, K. Kim, M. T. Cibeira, M. Beksac, E. Libby, J. ValentHungria, S. W. Wong, M. Rosenzweig, N. Bumma, A. Huart, M. A. Dimopoulos, D. Bhutani, A. J. Waxman, S. A. Goodman, J. A. Zonder, S. Lam, K. Song, T. Hansen, S. Manier, W. Roeloffzen, K. Jamroziak, F. Kwok, C. Shimazaki, J-S Kim, E. Crusoe, T. Ahmadi, N. P. Tran, X. Qin, S. Y. Vasey, B. Tromp, J. M. Schecter, B. M. Weiss, S. H. Zhuang, J. Vermeulen, G. Merlini*, R. L. Comenzo

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

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    Abstract

    Background Systemic immunoglobulin light-chain (AL) amyloidosis is characterized by deposition of amyloid fibrils of light chains produced by clonal CD38+ plasma cells. Daratumumab, a human CD38-targeting antibody, may improve outcomes for this disease. Methods We randomly assigned patients with newly diagnosed AL amyloidosis to receive six cycles of bortezomib, cyclophosphamide, and dexamethasone either alone (control group) or with subcutaneous daratumumab followed by single-agent daratumumab every 4 weeks for up to 24 cycles (daratumumab group). The primary end point was a hematologic complete response. Results A total of 388 patients underwent randomization. The median follow-up was 11.4 months. The percentage of patients who had a hematologic complete response was significantly higher in the daratumumab group than in the control group (53.3% vs. 18.1%) (relative risk ratio, 2.9; 95% confidence interval [CI], 2.1 to 4.1; P

    Daratumumab in Light-Chain Amyloidosis In a randomized trial of bortezomib, cyclophosphamide, and dexamethasone as compared with the same therapy plus daratumumab, patients with light-chain amyloidosis who received daratumumab had a higher frequency of hematologic complete response than those who did not (53.3% vs. 18.1%). Deaths were most commonly due to cardiac failure.

    Original languageEnglish
    Pages (from-to)46-58
    Number of pages13
    JournalNew England Journal of Medicine
    Volume385
    Issue number1
    DOIs
    Publication statusPublished - 1-Jul-2021

    Keywords

    • ANTIBODY DARATUMUMAB
    • AL AMYLOIDOSIS
    • DIAGNOSIS
    • CRITERIA

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