The Potential Role of CAR T Therapy in AL Amyloidosis

This is a video synopsis/summary of a Peer Exchange involving Heather Landau, MD; Vaishali Sanchorawala, MD; and Jeffrey Zonder, MD.

For previously treated patients with relapse/refractory light chain (AL) amyloidosis, an unmet medical need persists as there are currently no approved drugs in this space. Despite the success of the ANDROMEDA trial, where 60% of patients achieved a complete hematologic response, 40% did not meet this bar, highlighting the need for effective second-line therapies. The challenge intensifies when patients experience progression during daratumumab maintenance. The role of chimeric antigen receptor (CAR) T cells in this patient population is being explored, considering their revolutionary impact on hematologic malignancies, particularly in multiple myeloma.

Two B-cell maturation antigen (BCMA)-directed CAR T-cell agents, cilta-cel and ide-cel, have shown exceptional activity in various lines of therapy for multiple myeloma. In AL amyloidosis, BCMA is expressed on amyloidogenic plasma cells, providing a rationale for CAR T-cell studies. However, challenges arise due to organ dysfunction associated with amyloidosis, raising concerns about the capacity of affected organs to withstand potential adverse effects like cytokine release syndrome and neurotoxicity associated with CAR T-cell therapy. Research aims to decipher the mechanism of action and assess the suitability of CAR T cells for patients with AL amyloidosis.

Video synopsis is AI-generated and reviewed by OncLive^® editorial staff.