Assessing the treatment effect of daratumumab by serial meas
Daratumumab, an anti-human CD38 monoclonal antibody, has become the standard of care in patients with systemic light-chain (AL) amyloidosis and multiple myeloma (MM). The author reports two cases of AL cardiac amyloidosis with MM who were treated with daratumumab, lenalidomide, and dexamethasone (DRd). Serial evaluation of cardiac biomarkers, echocardiography, and cardiac magnetic resonance imaging (CMR) was performed during 12 months of DRd treatment. A complete hematologic response was achieved three months after treatment initiation and sustained during the observation period. Twelve months after DRd treatment, they found improvements in levels of B-type natriuretic peptide, N-terminal pro-brain natriuretic peptide, high-sensitivity cardiac troponin T, and global longitudinal strain. CMR revealed no noticeable changes in native T1 value or extracellular volume fraction. However, one case showed decreased native T2 value. In conclusion, DRd treatment improved heart failure and cardiac function relieved myocardial damage, and prevented amyloid deposition progression in patients with AL cardiac amyloidosis. Cardiac biomarkers and imaging findings may be useful for monitoring the therapeutic effects of daratumumab-containing regimens.