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Bellofiore C, Benvenuti P, Mina R, Basset M, Foli A, Nanci M, Nuvolone M, Guida G, Attanasio A, Mussinelli R, Mangiacavalli S, Cartia CS, Masoni V, Palumbo M, Cani L, Oliva S, Consoli U, Conticello C, Di Raimondo F, Arcaini L, Bringhen S, Merlini G, Palladini G, Milani P. A real-life study of daratumumab combinations in newly diagnosed patients with light chain (AL) amyloidosis. Hematol Oncol 2024; 42:e3289. [PMID: 38824453 DOI: 10.1002/hon.3289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/28/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
Daratumumab-based regimens are the new standard of care for newly diagnosed patients with AL amyloidosis based on the results of the ANDROMEDA study. However, real-world data on daratumumab efficacy in upfront therapy in unselected patients are scanty. In the framework of a prospective observational study, we investigated the efficacy and safety of daratumumab in 88 newly diagnosed patients, including subjects with IIIb cardiac stage (26%) or myeloma defining events (29%). Daratumumab was administered with bortezomib in 50 (56%) patients, lenalidomide in 31 (35%), and monotherapy in 7 (8%). The rate of serious adverse events was low (16%). The overall hematologic response rate was 75% with 52 (59%) patients attaining at least a very good partial response (VGPR) at six months. Amongst patients evaluable for organ response, the rate of cardiac and renal responses at 6 months was 31% and 21%, respectively. Comparing stage IIIb patients with the remaining ones, the rate of profound hematologic response was not significantly different (≥VGPR 57% vs. 59%, p 0.955) likewise the rate of cardiac (33% vs. 30%, p 0.340) and renal (40% vs. 16%, p 0.908) responses. Daratumumab-based regimens demonstrated to be safe and effective in treatment-naïve AL amyloidosis even in advanced stage disease.
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Affiliation(s)
- Claudia Bellofiore
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
- Hematology Unit, ARNAS Garibaldi, Catania, Italy
| | - Pietro Benvenuti
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Roberto Mina
- Division of Haematology, University of Torino, Torino, Italy
| | - Marco Basset
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Andrea Foli
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Martina Nanci
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Mario Nuvolone
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Gianluigi Guida
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Andrea Attanasio
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Roberta Mussinelli
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | | | | | - Valeria Masoni
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele Palumbo
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Cani
- Division of Haematology, University of Torino, Torino, Italy
| | - Stefania Oliva
- Division of Haematology, University of Torino, Torino, Italy
| | - Ugo Consoli
- Hematology Unit, ARNAS Garibaldi, Catania, Italy
| | - Concetta Conticello
- Division of Haematology, AOU "Policlinico G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Francesco Di Raimondo
- Division of Haematology, AOU "Policlinico G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Bringhen
- Division of Haematology, University of Torino, Torino, Italy
| | - Giampaolo Merlini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Giovanni Palladini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Paolo Milani
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
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Xing Y, Li X, Zhao J, Wu H, Zhao L, Zheng W, Sun S. Advancing precision medicine in immunoglobulin light-chain amyloidosis: a novel prognostic model incorporating multi-organ indicators. Intern Emerg Med 2024:10.1007/s11739-024-03621-8. [PMID: 38743128 DOI: 10.1007/s11739-024-03621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
To develop a more accurate prognostic model that incorporates indicators of multi-organ involvement for immunoglobulin light-chain (AL) Amyloidosis patients. Biopsy-proven AL amyloidosis patients between January 1, 2012, and February 28, 2023, were enrolled and randomly divided into a training set and a test set at a ratio of 7:3. Prognostic indicators that comprehensively cover cardiac, renal, and hepatic involvement were identified in the training set by random survival forest (RSF). Then, RSF and Cox models were established. The Concordance index (C-index) and integrated brier scores (IBS) were applied to evaluate the models' performance in the test set. Besides, the net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated. A total of 173 eligible patients were included. After a median follow-up of 25.9 (9.2, 50.3) months, 48 (27.7%) patients died. Creatine kinase-MB, estimated glomerular filtration rate ≤ 50 mL/min/1.73 m2, interventricular septum ≥ 15 mm, ejection fraction, alanine aminotransferase and Live involved were selected to develop prediction models. The RSF model based on the above indicators achieved C-index and IBS values of 0.834 (95% CI 0.725-0.915) and 0.151 (95% CI 0.1402-0.181), respectively. At last, the NRI and IDI of the RSF model were 0.301 (95% CI 0.048-0.546, P = 0.012) and 0.157 (95% CI 0.041-0.269, P < 0.001) at 5-year by comparing the RSF model with the Cox model which is based on the Mayo 2012 staging system. The RSF model that incorporates indicators of multi-organ involvement had a great performance, which may be helpful for physicians' decision-making and more accurate overall survival prediction.
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Affiliation(s)
- Yan Xing
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, No.127 Chang Le West Road, Xi'an, 710032, Shaanxi, China
| | - Xiayin Li
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, No.127 Chang Le West Road, Xi'an, 710032, Shaanxi, China
| | - Jin Zhao
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, No.127 Chang Le West Road, Xi'an, 710032, Shaanxi, China
| | - Hao Wu
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, No.127 Chang Le West Road, Xi'an, 710032, Shaanxi, China
| | - Lijuan Zhao
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, No.127 Chang Le West Road, Xi'an, 710032, Shaanxi, China
| | - Wanting Zheng
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, No.127 Chang Le West Road, Xi'an, 710032, Shaanxi, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, No.127 Chang Le West Road, Xi'an, 710032, Shaanxi, China.
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Chakraborty R, Bhutani D, Mapara M, Reshef R, Maurer MS, Radhakrishnan J, Lentzsch S. Reduced early mortality with Daratumumab-based frontline therapy in AL amyloidosis: A retrospective cohort study. Am J Hematol 2024; 99:477-479. [PMID: 38100285 DOI: 10.1002/ajh.27179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Affiliation(s)
| | - Divaya Bhutani
- Columbia University Irving Medical Center, New York, New York, USA
| | - Markus Mapara
- Columbia University Irving Medical Center, New York, New York, USA
| | - Ran Reshef
- Columbia University Irving Medical Center, New York, New York, USA
| | - Mathew S Maurer
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Suzanne Lentzsch
- Columbia University Irving Medical Center, New York, New York, USA
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Levin D, Lewis E, McCulloch S, Lee H, Tay J, Duggan P, Neri P, Bahlis N, Jimenez-Zepeda VH. Daratumumab for the treatment of relapsed/refractory AL amyloidosis: experience from the amyloidosis Program of Calgary (APC). Leuk Lymphoma 2024; 65:403-406. [PMID: 38054823 DOI: 10.1080/10428194.2023.2290468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Daniel Levin
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Ellen Lewis
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Sylvia McCulloch
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Holly Lee
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Jason Tay
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
| | - Peter Duggan
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
| | - Paola Neri
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
| | - Nizar Bahlis
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
| | - Victor H Jimenez-Zepeda
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
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Gertz MA. Immunoglobulin light chain amyloidosis: 2024 update on diagnosis, prognosis, and treatment. Am J Hematol 2024; 99:309-324. [PMID: 38095141 DOI: 10.1002/ajh.27177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
DISEASE OVERVIEW Immunoglobulin light chain amyloidosis is a clonal, nonproliferative plasma cell disorder in which fragments of immunoglobulin light or heavy chain are deposited in tissues. Clinical features depend on organs involved but can include heart failure with preserved ejection fraction, nephrotic syndrome, hepatic dysfunction, peripheral/autonomic neuropathy, and "atypical smoldering multiple myeloma or MGUS." DIAGNOSIS Tissue biopsy stained with Congo red demonstrating amyloid deposits with apple-green birefringence is required for the diagnosis of AL amyloidosis. Organ biopsy is not required in 85% of patients. Verification that amyloid is composed of immunoglobulin light chains is mandatory. The gold standard is laser capture mass spectroscopy. PROGNOSIS N-terminal pro-brain natriuretic peptide (NT-proBNP or BNP), serum troponin T(or I), and difference between involved and uninvolved immunoglobulin free light chain values are used to classify patients into four stages; 5-year survivals are 82%, 62%, 34%, and 20%, respectively. THERAPY All patients with a systemic amyloid syndrome require therapy to prevent deposition of amyloid in other organs and prevent progressive organ failure. Current first-line therapy with the best outcome is daratumumab, bortezomib, cyclophosphamide, and dexamethasone. The goal of therapy is a ≥VGPR. In patients failing to achieve this depth of response options for consolidation include pomalidomide, stem cell transplantation, venetoclax, and bendamustine. FUTURE CHALLENGES Delayed diagnosis remains a major obstacle to initiating effective therapy prior to the development of end-stage organ failure. Trials of antibodies to deplete deposited fibrils are underway.
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Affiliation(s)
- Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Bal S, Estrada-Merly N, Costa LJ, Qazilbash MH, Kumar S, D'Souza A. Outcomes of t(11;14) light chain (AL) amyloidosis after autologous stem cell transplantation: benchmark for new therapies. Blood Cancer J 2023; 13:170. [PMID: 37968258 PMCID: PMC10651880 DOI: 10.1038/s41408-023-00945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Susan Bal
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Noel Estrada-Merly
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Luciano J Costa
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Muzaffar H Qazilbash
- Division of Cancer Medicine, Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, TX, USA
| | - Shaji Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Lewis E, McCulloch S, Mahe E, Bahlis N, Neri P, Tay J, Duggan P, Jimenez-Zepeda VH. Effect of the Presence of t(11;14) for Patients With AL Amyloidosis Treated With Bortezomib-Containing Regimens: Experience From the Amyloidosis Program of Calgary. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e331-e334. [PMID: 37532664 DOI: 10.1016/j.clml.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Ellen Lewis
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada
| | - Sylvia McCulloch
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada
| | - Etienne Mahe
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Department of Pathology and Lab Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nizar Bahlis
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
| | - Paola Neri
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jason Tay
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
| | - Peter Duggan
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
| | - Victor H Jimenez-Zepeda
- Department of Medical Oncology and Hematology, Tom Baker Cancer Centre/University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada.
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