Management of Cardiac Amyloidosis

For AL cardiac amyloidosis, initiate daratumumab-based chemotherapy (Dara-CyBorD) immediately as first-line therapy, while for ATTR cardiac amyloidosis, start tafamidis or acoramidis as disease-modifying therapy alongside aggressive diuresis for heart failure symptoms.

Disease-Modifying Therapy by Subtype

AL Amyloidosis: Plasma Cell-Directed Treatment

The primary goal is eradicating the clonal plasma cells producing toxic light chains. Daratumumab combined with cyclophosphamide, bortezomib, and dexamethasone (Dara-CyBorD) is now the preferred first-line regimen 1external link, opens in a new tab. This has largely supplanted high-dose melphalan with autologous stem cell transplantation (HDM/SCT), though SCT remains an option for highly selected patients with low cardiac burden