Dr. D’Souza on the Utilization of Monoclonal Antibodies and Immunomodulating Agents in AL Amyloidosis

Anita D’Souza, MD, an associate professor at the Medical College of Wisconsin, discusses the utilization of monoclonal antibodies and immunomodulating agents in patients with light chain (AL) amyloidosis.

Monoclonal antibodies, such as daratumumab (Darzalex) and isatuximab-irfc (Sarclisa), are effective frontline treatment options for patients with relapsed AL amyloidosis, according to D'Souza. These agents have been shown to elicit rapid, deep hematologic and organ responses. Additionally, an ongoing phase 2 SWOG S1702 trial is examining the role of isatuximab in patients with relapsed/refractory disease.

The other class of agents being utilized in this patient population are immunomodulatory drugs, such as lenalidomide (Revlimid) and pomalidomide (Pomalyst). Although patients with amyloidosis have been shown to have some difficulty tolerating these agents, they can still be safely administered as long as the risks are considered, D'Souza says. For example, a lower dose of lenalidomide can be given, with patients receiving 15 mg instead of 25 mg, which is typically given to those with multiple myeloma.

Notably, almost all patients can have a paradoxical increase in cardiac biomarkers without experiencing worsening heart failure, even as their free light chains demonstrate improvement, D'Souza concludes.