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Immunotherapy in AL Amyloidosis.

Yifei Zhang¹, Raymond L Comenzo²

¹Division of Hematology and Oncology, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA.

Current Treatment Options in Oncology

|May 31, 2022

Summary

Immunotherapy, particularly monoclonal antibodies like daratumumab, offers promising treatments for light-chain amyloidosis (AL) by targeting abnormal plasma cells. These therapies are crucial for improving organ function and survival in AL patients.

Keywords:

AL amyloidosis Daratumumab Immunotherapy Monoclonal antibody

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Area of Science:

Hematology
Immunology
Oncology

Background:

Light-chain amyloidosis (AL) is a rare plasma cell disorder characterized by toxic light chain deposition in organs.
Cardiac involvement significantly impacts survival, necessitating rapid light chain reduction for recovery.
Immunotherapy targeting clonal plasma cells and amyloid deposits is a key treatment strategy.

Purpose of the Study:

To review the role of immunotherapy in treating light-chain amyloidosis.
To highlight the efficacy of monoclonal antibodies in improving patient outcomes.
To discuss emerging immunotherapies for AL amyloidosis.

Main Methods:

Review of current literature on immunotherapy for AL amyloidosis.
Analysis of clinical trial data for agents like daratumumab, isatuximab, and elotuzumab.
Discussion of novel immunotherapeutic approaches under investigation.

Main Results:

Daratumumab, alone or in combination, achieves deep hematologic responses and improves outcomes in AL amyloidosis.
Other monoclonal antibodies (isatuximab, elotuzumab) and CAEL101 show promise.
Monoclonal antibodies offer a low-toxicity option suitable for frail AL patients.

Conclusions:

Immunotherapy, especially monoclonal antibodies, has transformed AL amyloidosis treatment.
Ongoing research into novel agents like CAR T-cells and bispecific antibodies holds future promise.
Addressing patient frailty and disease relapses remains critical in AL amyloidosis management.