Characterizing a racially diverse cohort of patients with AL amyloidosis treated with dara-VCD

Abstract AL amyloidosis is a rare but life-threatening plasma cell disorder characterized by the deposition of misfolded immunoglobulin light chains in vital organs, leading to progressive organ dysfunction and high early mortality, particularly when cardiac involvement is present (Sanchorawala 2024). Black individuals are disproportionately affected, often presenting at younger ages and with more advanced disease (Staron 2020). Despite this, Black patients remain significantly underrepresented in clinical trials. In the pivotal ANDROMEDA study, which established daratumumab plus bortezomib, cyclophosphamide, and dexamethasone (Dara-VCD) as the standard of care, only 6 of 194 patients in the Dara-VCD arm (3.1%) self-identified as Black (Kastritis 2024). The Phase II AQUARIUS study, designed to explore Dara-VCD in more diverse populations, similarly aimed to enroll about 15-30 Black patients out of 150 (10-20%) (Rosenzweig 2023). To evaluate the real-world applicability of ANDROMEDA findings to a more representative U.S. population, we established the Emory Amyloid Database to characterize a racially diverse single-center cohort treated with Dara-VCD. This retrospective study includes 48 patients with biopsy-confirmed AL amyloidosis who initiated Dara-VCD as their first-line treatment at Emory University-affiliated hospitals between October 2022 and February 2025. Nearly half (47.9%, n=23) self-identified as Black. Baseline clinical characteristics were similar across racial groups, including median age at diagnosis (Black: 64; non-Black: 66 years, p=0.35), rates of cardiac involvement (Black: 56.5%; non-Black: 48.0%, p=0.58), renal involvement (Black: 52.2%; non-Black: 61.5%, p=0.38), and Mayo stage distribution. Cytogenetic data was available for 31 patients (65%). Hematologic response rates exceeded 90% in both groups (Black: 90.0%; non-Black: 91.7%, p=1.00), with comparable rates of complete response (Black: 36.8%; non-Black: 36.4%, p=1.00) and very good partial response (Black: 42.1%; non-Black: 54.5%, p=0.56). However, median time to hematologic response was significantly longer among Black patients (62 vs 37 days, p=0.02). These real-world findings highlight that Black and non-Black patients with AL amyloidosis in our cohort had broadly similar baseline clinical features, including age at diagnosis, organ involvement, and baseline disease severity. Hematologic response rates were also comparable across groups. The observed delay in time to response among Black patients warrants further investigation to explore potential differences in relative dose intensity, disease biology, or care delivery factors. Future analyses will examine longitudinal outcomes, including organ response and overall survival. These data provide a critical resource for understanding disease presentation and early treatment response in a racially diverse population, supporting the generalizability of clinical trial findings and informing future efforts to improve equity in amyloidosis care and research.