Systemic light chain amyloidosis myopathy responsive to daratumumab monotherapy

Abstract

Background and purpose Amyloid myopathy is a rare and severe manifestation of systemic light chain (AL) amyloidosis. Early diagnosis and staging are mandatory for optimal therapy, given the rapid progression of muscle weakness. Despite the efficacy of bortezomib‐based treatment regimens, there is a lack of therapeutic alternatives in non‐responsive patients. Method The case report of a patient with systemic AL amyloidosis myopathy treated with daratumumab is presented. Results A 70‐year‐old man displayed severe proximal muscle weakness which had developed over a 10‐month period. Blood tests revealed an immunoglobulin A lambda monoclonal gammopathy, whilst muscle biopsy showed amyloid deposits within the arteriolar walls, confirming the diagnosis of amyloid myopathy associated with AL amyloidosis. Initial treatment with a bortezomib‐based regimen showed no clinical or hematological improvement. After switching to daratumumab monotherapy, our patient achieved a favorable evolution with respect to functional muscle scoring and a complete hematological response. Conclusion To our knowledge, this is the first case report of an amyloid myopathy showing a remarkable clinical improvement in response to daratumumab monotherapy. It thereby highlights the potential of daratumumab as a monotherapeutical approach to the treatment of amyloid myopathy complicating AL amyloidosis.