I'm seeing a 55 y/o F with AL amyloidosis, presenting with biopsy-proven cardiac involvement with EF 24%, recurrent pleural effusions requiring frequent therapeutic thoracentesis. Her Mayo Cardiac stage is IIIB. I'm inclined to follow the ANDROMEDA protocol (Dara-CyBorD), however the trial only included patients cardiac stage IIIA and below. I am curious if you would agree or take a different approach, given the overall poor prognosis/aggressiveness of cardiac stage IIIB disease
There have been a few studies looking at giving single agent daratumumab in patients with Mayo Cardiac IIIB disease. I think this is a reasonable place to start with patients like this. after a cycle or two if you are not seeing appropriate serologic response you can add in the bortezomib and/or the cytoxan. please see the link to this study here: https://ashpublications.org/blood/article/138/Supplement%201/2730/481394/Efficacy-and-Safety-of-Daratumumab-Monotherapy-in
