No items found.
I am seeing a 65 y/o patient with initially smoldering myeloma (20-30% plasma cells on marrow, IgA lambda, lambda light chain 25, M spike 1.8, no CRAB findings) who was found to have biopsy proven cardiac AL amyloidosis, Mayo 2012 cardiac stage II She is now on Dara-CyBorD x2 cycles thus far and appears to be responding, light chains have normalized and M spike is 0.9. Do you typically recommend auto transplant for these patients?
I often don't nowadays as these patients respond so well. You need to continue current therapy to reduce the plasma cell burden but if you've already normalized the flc ratio odds are you've stopped the patient from laying down more amyloid. I generally give 4-6 cycles of induction and then complete a total of 2 years of dara maintenance. ie if you gave 6 cycles of daracybord i then give 18 cycles of dara maintenance.
