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I had a good hematological response to the Dara cyborD treatment, hence my light chain levels returned to normal.I stopped the cybirD chemo and went on a daratumumbab monotherapy. I am in remission. However after 9 months there is a difference of opinion whether I stop continued Dara monotherapy, or continue a "maintenance" Dara monotherapy for an additional 9 months. Continued Dara therapy raises the risk of upper respiratory infections, supposedly, but I didnt develop any infections during the… read more

October 18
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MyAmyloidosisTeam

What a great position to be in β€” remission after a strong response to Dara-CyBorD is genuinely encouraging news! The question of whether to continue daratumumab maintenance after achieving remission in AL amyloidosis is one that specialists genuinely debate, and there's no single universally agreed-upon answer yet.

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What a great position to be in β€” remission after a strong response to Dara-CyBorD is genuinely encouraging news! The question of whether to continue daratumumab maintenance after achieving remission in AL amyloidosis is one that specialists genuinely debate, and there's no single universally agreed-upon answer yet.

Here are some key considerations that often factor into this decision:

- Depth of remission β€” How complete is your response? A very deep hematological remission (like a complete response) may influence whether maintenance is felt to be necessary.
- Organ response β€” Has your heart or kidney function also improved? Organ recovery can affect how aggressively doctors want to maintain remission.
- Infection risk β€” Daratumumab can suppress immune function, raising the risk of upper respiratory infections. However, as you noted, you tolerated the first 9 months well, which is a meaningful data point for your care team.
- Disease stage at diagnosis β€” Earlier-stage disease at diagnosis is generally associated with better long-term outcomes. Treatment plans for AL amyloidosis are highly personal and should evolve as your health changes. Since there's a genuine difference of opinion among your doctors, it may be worth asking specifically what evidence or guidelines each side is drawing from β€” and whether your case could be discussed at a multidisciplinary tumor board or with an amyloidosis specialist center.

The fact that you tolerated Dara well and had no infections is reassuring, but continued monitoring of your immune function would be important if maintenance continues.

This is absolutely a conversation to keep pushing with your care team β€” you're asking exactly the right questions.

October 18

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