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Induction therapy
Source: Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 25, 2025 · Captured 2026-09-09.
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As is true for all plasma cell dyscrasias, responses have been reported for patients treated with all the same regimens active in multiple myeloma.[4-12] Lower doses of lenalidomide or pomalidomide must be used in patients with renal dysfunction.[13] Patients with amyloidosis respond to treatment with daratumumab, with or without other active agents. Daratumumab is usually combined with other agents used for myeloma.[14-20] Rapid responses to induction therapy may result in improvement of renal or cardiac function.[21,22]
Evidence (chemotherapy):
A prospective trial (NCT03201965) included 388 previously untreated patients with immunoglobulin light-chain amyloidosis (excluding symptomatic myeloma). Patients were randomly assigned to receive bortezomib, cyclophosphamide, and dexamethasone with or without subcutaneous daratumumab.[23]Daratumumab combined with bortezomib, cyclophosphamide, and dexamethasone is considered a standard regimen for previously untreated patients who are eligible to receive this regimen. When using daratumumab induction therapy, the fluorescence in situ hybridization–detected cytogenetic abnormality of t(11;14) no longer confers an adverse prognostic impact. However, the presence of 1q gain continues to be associated with a lower response rate and hematologic event-free survival during treatment of amyloid light chain amyloidosis.[24]
Source links and citations
A prospective trial (NCT03201965) included 388 previously untreated patients with immunoglobulin light-chain amyloidosis (excluding symptomatic myeloma). Patients were randomly assigned to receive bortezomib, cyclophosphamide, and dexamethasone with or without subcutaneous daratumumab.[23]Daratumumab combined with bortezomib, cyclophosphamide, and dexamethasone is considered a standard regimen for previously untreated patients who are eligible to receive this regimen. When using daratumumab induction therapy, the fluorescence in situ hybridization–detected cytogenetic abnormality of t(11;14) no longer confers an adverse prognostic impact. However, the presence of 1q gain continues to be associated with a lower response rate and hematologic event-free survival during treatment of amyloid light chain amyloidosis.[24]
With a median follow-up of 11.4 months, the hematologic complete response rate was 53% for patients in the daratumumab group and 18.1% for patients in the control group (relative risk, 2.9; 95% confidence interval [CI], 2.1–4.1; P < .001). A landmark analysis at 6 months was also performed.[23][Level of evidence B3]
Source links and citations
A prospective trial (NCT03201965) included 388 previously untreated patients with immunoglobulin light-chain amyloidosis (excluding symptomatic myeloma). Patients were randomly assigned to receive bortezomib, cyclophosphamide, and dexamethasone with or without subcutaneous daratumumab.[23]Daratumumab combined with bortezomib, cyclophosphamide, and dexamethasone is considered a standard regimen for previously untreated patients who are eligible to receive this regimen. When using daratumumab induction therapy, the fluorescence in situ hybridization–detected cytogenetic abnormality of t(11;14) no longer confers an adverse prognostic impact. However, the presence of 1q gain continues to be associated with a lower response rate and hematologic event-free survival during treatment of amyloid light chain amyloidosis.[24]
Survival free from organ deterioration, hematologic progression, or death favored the daratumumab arm (hazard ratio, 0.58; 95% CI, 0.36–0.93; P = .02).
A prospective trial (NCT03201965) included 388 previously untreated patients with immunoglobulin light-chain amyloidosis (excluding symptomatic myeloma). Patients were randomly assigned to receive bortezomib, cyclophosphamide, and dexamethasone with or without subcutaneous daratumumab.[23]Daratumumab combined with bortezomib, cyclophosphamide, and dexamethasone is considered a standard regimen for previously untreated patients who are eligible to receive this regimen. When using daratumumab induction therapy, the fluorescence in situ hybridization–detected cytogenetic abnormality of t(11;14) no longer confers an adverse prognostic impact. However, the presence of 1q gain continues to be associated with a lower response rate and hematologic event-free survival during treatment of amyloid light chain amyloidosis.[24]
The cardiac and renal responses were doubled for patients in the daratumumab group, but no statistical analysis was provided.
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Preserved source evidence · Not medical advice