Taimur Sher, MBBS, MD

Taimur Sher, MBBS, MD, Associate Professor of Medicine, Hematology and Medical Oncology Consultant, and Director of the Multi-Specialty Amyloidosis Group at the Mayo Clinic in Jacksonville, Florida, told The ASCO Post that shutting down the source of amyloidogenic light-chain production—the transformed and neoplastic plasma cells—is the mainstay of treatment of immunoglobulin light-chain amyloidosis.

“Hematologic response, in particular complete response, is one of the key predictors of improvement in survival and quality of life,” said Dr. Sher. “The addition of daratumumab to the CyBorD regimen has demonstrated impressive improvement in complete response that translated into early organ response.”

In 2016, Dr. Sher and colleagues first reported the efficacy of daratumumab in two patients with advanced and refractory light-chain amyloidosis with multiorgan involvement whose disease failed to respond to all available lines of therapy. Both of them achieved complete hematologic response.

“Since daratumumab had to be given as a prolonged intravenous infusion with a significant amount of fluid volume, one of our main concerns had been aggravation of congestive heart failure in these patients,” said Dr. Sher. “Approximately half of patients with light-chain amyloidosis have some degree of heart involvement and are sensitive to volume overload. The subcutaneous administration is a significant advance that minimizes the chances of fluid overload and exacerbation of congestive heart failure. Additionally, the shorter infusion time may improve patients’ quality of life.” 

DISCLOSURE: Dr. Sher has served as a consultant for Alnylam and Janssen and has received research support from Akcea and Prothena.