Daratumumab for relapsed AL amyloidosis—When cumulative real-world data precedes clinical trials: A multisite study and systematic literature review

Tamir Shragai*, Moshe Gatt, Noa Lavie, Iuliana Vaxman, Tamar Tadmor, Ory Rouvio, Miri Zektser, Nethanel Horowitz, Hila Magen, Mouna Ballan, Celia Suru, Efrat Luttwak, Shai Levi, Tomer Ziv-Baran, Irit Avivi, Yael C. Cohen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Objectives: Patients with relapsed/refractory AL amyloidosis (RRAL) have poor prognosis, but emerging data shows promising results with the use daratumumab. We evaluated daratumumab treatment in RRAL in real-world setting. Methods: A retrospective multisite study of RRAL patients treated with daratumumab alone and in combinations. Results: Forty-nine patients, diagnosed between 1.1.2008 and 1.2.2018 were included; 27% also had multiple myeloma (MM). Revised Mayo score was ≥ 3 in 67%. Hematologic overall response rate was 81%, 64% achieved very good partial response (VGPR) or better. Concurrent active MM was associated with lower rates of VGPR (OR 0.19, 95% CI 0.04-0.81; P =.03) in a multi-variate analysis. Cardiac and renal responses were 74% and 73%, respectively. Median progression-free survival (PFS) was 28.4 months and median overall survival (OS) was not reached; 2-year PFS and OS were 68.6 ± 7.5% and 90.4 ± 4.6%, respectively. Hematologic response correlated with prolonged PFS and OS. Daratumumab was safe and well tolerated, no patients discontinued therapy due to toxicity. Our data was aligned with outcomes from a systematic literature review, which identified 10 case series (n = 517) and 2 clinical trials (n = 62) meeting prespecified criteria. Conclusions: Our data support favorable safety tolerability and efficacy of daratumumab among non-selective RRAL patients in a real-world setting.

Original languageAmerican English
Pages (from-to)184-195
Number of pages12
JournalEuropean Journal of Haematology
Volume106
Issue number2
DOIs
StatePublished - Feb 2021

Bibliographical note

Publisher Copyright:
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Keywords

  • cardiac amyloidosis
  • daratumumab
  • light-chain amyloidosis

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