Rapid response to single agent daratumumab is associated with improved progression-free survival in relapsed/refractory AL amyloidosis. (2nd July 2020)

• Record Type: Journal Article
• Authors: Cohen, Oliver C.; Brodermann, Maximillian H.; Blakeney, Iona J.; Mahmood, Shameem; Sachchithanantham, Sajitha; Ravichandran, Sriram; Law, Steven; Lachmann, Helen J.; Whelan, Carol J.; Popat, Rakesh; Rabin, Neil; Yong, Kwee; Kyriakou, Charalampia; Shah, Raakhee; Cheesman, Simon; Worthington, Sarah; Hawkins, Philip; Gillmore, Julian D.; Wechalekar, Ashutosh D.
• Is Part Of: Amyloid. Volume 27:Number 3(2020)
• Page Start: 200
• Page End: 205
• Publication Date: 2020-07-02
• Subjects: Daratumumab -- amyloidosis -- therapy; Amyloidosis -- Periodicals; 616.3995
• DOI: 10.1080/13506129.2020.1765768
• Languages: English
• ISSNs: 1350-6129

Abstract

Abstract: Background: Daratumumab is a monoclonal antibody, which targets CD38; an antigen expressed on malignant plasma cells in AL amyloidosis thus providing a rationale for its use. Method: Patients treated with daratumumab monotherapy (2016–2019) for relapsed/refractory systemic AL amyloidosis were identified from the database at the UK National Amyloidosis Centre. Results: Of 50 evaluable patients, haematological responses at 3 months were: CR – 19 (38%), VGPR – 14 (28%), PR – 9 (18%) and no response – 8 (16%). Median time to response was 1 (1–6) month. Of assessable patients, cardiac, renal and hepatic responses were seen in 43.8%, 25.0% and 0% of patients whilst progression occurred in 25.0%, 12.5% and 37.5% respectively. Patients achieving a CR had longer median OS (not reached vs. 22.7 months [95% CI 17.0–28.4 months]) ( p = .036). Furthermore, patients achieving a rapid response (at 1 month) had a longer median PFS (not reached vs. 9 months [95% CI 5.8–12.2 months]) ( p = .013). Conclusion: Daratumumab monotherapy is effective in multiply-relapsed systemic AL amyloidosis and should be considered, if available, in patients who have not received prior daratumumab therapy. Responses are achieved rapidly and overall response rate was 84%. CR predicts overall survival whilst speed of response is predictive of a longer PFS.