Management Algorithms for Relapsed/Refractory AL Amyloidosis

Authored by Rajshekhar Chakraborty, published on 2026-02-12 23:18:06.0

  1. Relapsed/Refractory AL Amyloidosis after Frontline Dara-CyBorD
    • Indications for switching therapy
      • <Heme-PR after 1 month • <Heme-VGPR after 3 months (or plateau in FLCs before 3 months) • <Heme-CR after 6 months in the setting of organ non-response/progression and residual clonal plasma cells in bone marrow • Hematologic relapse/pre/progression with dFLC>2 mg/dL as trigger for initiation of new clone-directed Rx
      • t(11;14)-positive
        • Treatment options (t(11;14)-positive)
          Preferred: BCMA BsAb* [off-label or clinical trial] Bcl2 inhibitor [off-label or clinical trial] BCMA CAR T [clinical trial] Alternative/Less Preferred: ASCT BCMA ADC IMiDs [Pom preferred over Len]
      • t(11;14)-negative or unknown
        • Treatment options (t(11;14)-negative or unknown)
          Preferred: BCMA BsAb* [off-label or clinical trial] BCMA CAR T [clinical trial] Alternative/Less Preferred: ASCT BCMA ADC IMiDs [Pom preferred over Len]
  2. * Consider fixed-duration treatment for 6 months
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