The relationship between an early decrease in the difference between involved and uninvolved free light chains (dFLC) and clinical outcomes in AL amyloidosis is significant. We conducted a multicenter study (n = 86, baseline dFLC ≥ 50 mg/L) in which all patients received frontline daratumumab-bortezomib therapy. ROC analysis identified a dFLC reduction after one cycle (87% reduction, AUC = 0.82) as predictive of complete hematologic response (CHR). Patients achieving >87% dFLC or a very good partial response after one cycle were classified as optimal responders (O-HR), while those who did not were classified as suboptimal response (S-HR). The O-HR group had higher rate of CHR (90.5% vs. 43.5%, p < 0.001), cardiac response (68.9% vs. 36.8%, p = 0.017), and renal response (76.6% vs. 50.0%, p = 0.045) than the S-HR group. Profound dFLC decrease after one cycle suggests high CHR and organ response likelihood, supporting early treatment modification.
Liu et al. (Wed,) studied this question.
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