Daratumumab in AL amyloidosis: survival, cardiac CR, and beyond

In this issue of Blood, Kastritis et al 1 report the final analysis of the ANDROMEDA trial, which compared daratumumab-CyBorD (cyclophosphamide, bortezomib, and dexamethasone) vs CyBorD alone in previously untreated systemic immunoglobulin light chain (AL) amyloidosis.The initial 2021 report established a threefold improvement in hematologic complete response (heme-CR) with daratumumab-CyBorD 2 ; the final analysis now confirms that this improvement in deep hematologic response translates into a clinically meaningful overall survival (OS) advantage, an absolute improvement of ~12% in 5 years. 1 Strikingly, this survival benefit emerged despite substantial crossover with 71% of patients in the control arm receiving a daratumumab-based regimen as subsequent therapy.