source: American Society of Clinical Oncology

year: 2018

authors: Jithma P. Abeykoon, Saurabh Zanwar, Shaji Kumar, Angela Dispenzieri, S. Vincent Rajkumar, Martha Lacy, David Dingli, Nelson Leung, Eli Muchtar, Wilson I. Gonsalves, Taxiarchis Kourelis, Francis Buadi, Robert A. Kyle, Morie A. Gertz, Prashant Kapoor

Background:

Treatment options for patients (pts) with relapsed/refractory (RR) AL amyloidosis are limited. Daratumumab (dara) has been approved as monotherapy (DMT) or combination therapy (DCT) for multiple myeloma (MM). Data for dara-based therapy (DBT) in AL are sparse.

Methods:

We studied pts with RR AL without coexisting MM seen at Mayo Clinic from 11/2015 to 02/2018 & treated with DBT. Hematologic response (HR) & organ response (OR) were defined per Consensus criteria. All time to event analyses were done from the time of DBT initiation. Pts with dFLC < 4 mg/dL at the time of start of DBT were considered non evaluable (NE) for HR other than disease progression. DCT included dara, pomalidomide & dexamethasone (dex) (35%), dara, lenalidomide & dex (26%), dara, bortezomib & dex (22%) & other DBT regimens (17%).

Results:

45 pts (DMT, n = 22; DCT, n = 23) received DBT; median age at DBT initiation was 64 years (range: 46-82). Data for HR assessment were available in 44 pts & 31 were evaluable for HR. HR & end points are outlined in Table 1. Among 13 NE pts, response improved to CR in 5 (38%) while remaining 8 continued to be NE. Of these 13 pts, 77% reached dFLC < 1 mg/dL at last follow up (FU). Cardiac, renal & liver involvement was observed in 59%, 43% & 7% of pts. Cardiac, renal and liver OR was 46%, 32%, 0%, respectively. At last FU, 31 pts were on DBT. Three (7%) pts had disease progression. Hematologic toxicity (HT) from DBT included anemia ≤2 grade (Gr = ) 69%, 3 Gr 3%; thrombocytopenia 1 Gr 38%; neutropenia ≤2 Gr21% &> 2 Gr 7%. Non-HTs included fatigue (23%), infusion reactions (21%), & treatment-emergent neuropathy (14%).

Conclusions:

DBT is safe & effective in heavily pretreated pts with AL. HR is achieved rapidly with DBT, particularly with DCT.

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