Limited duration of dexamethasone in newly diagnosed AL amyloidosis: impact on response, toxicity, and survival.

Authors

John Hanna, Hong Li, Ryan Brown, Zain Ali Burney, Kawther Abdallah, Diana Basali, Jason Valent, Christy Samaras, Faiz Anwer, Jack Khouri, Shahzad Raza, Willem Van Heeckeren, Mazen Hanna, J Emanuel Finet, Louis Williams, Sandy Mazzoni

Published in

Annals of medicine. Volume 58. Issue 1. Pages 2693452. Epub Aug 07, 2026.

Abstract

Systemic light chain amyloidosis (AL) is a life-threatening disease in which dexamethasone (Dex) is a core therapy but is limited by cumulative toxicity. The optimal duration of Dex, particularly in the era of daratumumab (Dara)-based regimens, is uncertain.
We retrospectively analyzed 216 newly diagnosed AL amyloidosis patients (2017-2023). Dex exposure was categorized as limited (≤3 months) or prolonged (>3 months) using restricted cubic spline-derived associations with hematologic response kinetics. Outcomes included hematologic and organ response, toxicity, and overall survival.
Median Dex duration was 5.5 months and was similar by Dara use. Overall response rates exceeded 90% at 6 months in both Dex groups. Limited Dex was associated with higher rates of early deep hematologic response (VGPR or better 77.5 vs 56.5%, p = 0.001; CR 42.2 vs 19.4%, p < 0.001), reflecting faster response kinetics, while overall response rates were similar. Among patients receiving limited Dex, Dara was associated with higher 6-month CR rates (66.7 vs 30.4%, p < 0.001) and increased likelihood of achieving CR in multivariable analysis (HR 4.38, 95% CI 2.44-7.85; p < 0.001). Organ responses were similar between groups. Dex-related toxicities increased after 6 months, and hospitalization was associated with worse survival.
Limiting Dex exposure was associated with preserved efficacy and reduced toxicity. Prolonged Dex was associated with increased toxicity without improving overall hematologic or organ outcomes, supporting limited Dex duration in frontline AL amyloidosis therapy.

PMID:
42566913
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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