Abstract: FR-OR008
Daratumumab Monotherapy vs. Bortezomib-Based Regimen in Frail Patients with Renal AL Amyloidosis Ineligible for Kidney Transplantation
Session Information
- Advancing Onconephrology Precision: Biomarkers, Therapeutic Targets, and Patient Outcomes
October 23, 2026 | Location: Room 401, Convention Center
Abstract Time: 05:40 PM - 05:50 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Fenoglio, Roberta, Ospedale San Giovanni Bosco, Turin, Piedmont, Italy
- Sciascia, Savino, Ospedale San Giovanni Bosco, Turin, Piedmont, Italy
- Roccatello, Dario, Ospedale San Giovanni Bosco, Turin, Piedmont, Italy
Background
Bortezomib based regimens have long represented the standard option for systemic AL amyloidosis, whereas daratumumab has recently emerged as a promising alternative. We compared two consecutive single center cohorts of frail, non transplant eligible patients treated with either bortezomib based therapy or daratumumab monotherapy, assessing clinical and renal outcomes
Methods
Thirty one patients with renal AL amyloidosis were included: 17 received bortezomib-based regimens (historical cohort) and 14 received daratumumab monotherapy (prospective cohort). All had biopsy confirmed renal amyloid deposition and were transplant ineligible. Hematologic and organ responses followed International Society of Amyloidosis criteria
Results
Baseline characteristics were similar between cohorts. Hematologic response rates were 57.1% with bortezomib versus 92.8% with daratumumab (p=0.03), with complete responses in 28.6% and 57.1%, respectively. Renal response occurred in 35% of bortezomib-treated patients versus 71.4% with daratumumab (p=0.04). Proteinuria declined by 76% in bortezomib responders and 72% in daratumumab responders, with stable creatinine in both groups. Among patients achieving dual hematologic and renal responses, 12 month survival was 100% in the daratumumab cohort versus 71% in the historical group. At last follow-up, renal survival was 67% versus 86%, and overall survival 47% versus 79% (p=0.08). Major infections occurred in 18% and 14%, respectively. Repeat biopsies showed stabilization or regression of amyloid in 62% of daratumumab treated versus 20% of historical cases
Conclusion
In frail, ASCT ineligible patients with biopsy-proven renal AL amyloidosis, daratumumab monotherapy yielded higher hematologic and renal response rates compared with bortezomib-based regimens. These findings support early anti CD38 therapy as a potential strategy to improve renal preservation and survival, warranting confirmation in multicenter trials