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This algorithm covers biopsy-proven systemic AL amyloidosis and organizes plasma-cell-directed therapy by disease setting. Before treatment, AL type should be confirmed by typing (to exclude ATTR), and patients are staged with cardiac biomarkers (NT-proBNP and troponin), which drive prognosis and treatment intensity.
For newly diagnosed disease, the standard first-line regimen is daratumumab plus VCd, supported by ANDROMEDA, in which adding subcutaneous daratumumab to VCd tripled the hematologic complete response rate and improved cardiac and renal organ responses, establishing daratumumab-based therapy as the standard of care. Selected fit, transplant-eligible patients with low-stage disease may consolidate with induction followed by autologous stem cell transplantation. In the relapsed or refractory setting, the chart splits by prior exposure and biomarker: daratumumab-based therapy for patients who are daratumumab naive, and venetoclax-based therapy as a biomarker-directed option for patients whose clone carries t(11;14).
Background reading: AL Amyloidosis board review notes.
Plasma-cell-directed therapy staged by cardiac biomarkers. Starting point: Systemic AL amyloidosis biopsy-proven. Full background: AL Amyloidosis notes.
Simplified board-prep scaffold; verify against current guidelines and primary literature. Confirm AL (not ATTR) by typing; stage with cardiac biomarkers (NT-proBNP, troponin). Daratumumab-based therapy is the new standard of care.