Teclistamab plus daratumumab for newly diagnosed AL amyloidosis

A Phase 2 Clinical Trial of Teclistamab and Daratumumab in Previously Untreated AL Amyloidosis

This tests whether combining teclistamab with daratumumab is safe and helps people newly diagnosed with AL amyloidosis by lowering harmful light chains and protecting organ function.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 25 (estimated)
• Ages: 18 Years to 100 Years
• Sex: All
• Sponsor: Columbia University (Academic / other)
• Drugs / interventions: teclistamab, daratumumab
• Locations: 1 site (New York, New York)
• Trial ID: NCT07110844 on ClinicalTrials.gov

What this trial studies

This phase 2 interventional trial tests a combination of teclistamab and daratumumab (with hyaluronidase-fihj) in adults with newly diagnosed, untreated systemic AL amyloidosis. Treatment is given in 28-day cycles and is expected to last about six months, with scheduled infusions and follow-up visits to monitor blood light-chain levels, organ function, and side effects. The main goals are to produce deep hematologic responses, limit further organ damage, and document safety and tolerability of the combination. Outcomes include change in involved free light chains, organ responses, and adverse events.

Who should consider this trial

Good fit: Adults (age >18) with biopsy-proven systemic AL amyloidosis who have not received prior plasma cell–directed therapy, have measurable disease (e.g., elevated dFLC or M-protein), and have ECOG performance status 0–2 are ideal candidates.

Not a fit: People who have already received plasma cell–directed treatment, have localized (non-systemic) amyloid, or have irreversible end-stage organ failure are unlikely to benefit from this regimen.

Why it matters

Potential benefit: If successful, the combination could rapidly lower toxic amyloid-forming light chains, reduce progression of organ damage, and improve organ function and survival.

How similar studies have performed: Daratumumab-containing regimens have shown clear benefit in newly diagnosed AL amyloidosis, while teclistamab is approved for multiple myeloma—combining them is a novel approach with limited prior data in AL amyloidosis.

Eligibility criteria

Inclusion Criteria:

1. Age \>18 years and able to sign Informed Consent Form (ICF). If the individual being considered for participation in this study is unable to provide informed consent due to medical, cognitive, or other conditions, a legally authorized representative (LAR) may consent on their behalf.
2. Ability to comply with the study protocol, in the investigator's judgment.
3. Confirmed histopathological diagnosis of systemic AL amyloidosis by mass spectrometry or immunohistochemistry (IHC) or Immunofluorescence (IF) on a tissue biopsy that is positive for Congo Red.
4. Patient must not have received any prior plasma cell clone-directed therapy.
5. Measurable hematologic disease, defined as one of the following:

   1. Difference between involved and uninvolved serum free light chain (dFLC) ≥50 mg/L and/or 5 mg/dL
   2. Serum M-protein ≥0.5 g/dL on protein electrophoresis
6. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.
7. One or more organs involved by AL amyloidosis as per consensus guidelines
8. Pre-treatment clinical laboratory values meeting the following criteria during the screening phase:

   1. Absolute neutrophil count ≥0.75 × 10\^9/L
   2. Hemoglobin level ≥8.0 g/dL; red blood cell transfusion allowed until 7 days before C1D0.
   3. Platelet count ≥50 × 10\^9/L; Platelet transfusions are acceptable without restriction during the Screening period
   4. Alanine aminotransferase level (ALT) ≤2.5 times the Upper Limit of Normal (ULN)
   5. Aspartate aminotransferase (AST) ≤2.5 times the ULN
   6. Total bilirubin level ≤1.5 × ULN except for subjects with Gilbert syndrome, in which case direct bilirubin ≤2 × ULN
   7. Estimated glomerular filtration rate (eGFR) ≥20 mL/min/1.73 m\^2, measured by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
9. For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraception and agreement to refrain from donating eggs.

For men: Agreement to remain abstinent (refrain from heterosexual intercourse) or use a condom, and agreement to refrain from donating sperm.

Exclusion Criteria:

1. Prior therapy for AL amyloidosis or multiple myeloma with the exception of 160 mg dexamethasone (or equivalent corticosteroid) maximum exposure prior to C1D0.
2. Patients meeting criteria for symptomatic multiple myeloma by any one of the following: (a) Lytic lesions on imaging (Skeletal survey, whole body CT or MRI, or PET/CT) (b) Plasmacytoma, (c) Hypercalcemia without any alternate etiology, (d) Bone marrow plasma cell infiltrate of greater than 60%.

   Patients with involved/uninvolved serum FLC ratio\>100 as the sole myeloma-defining event will be allowed.
3. Evidence of significant cardiovascular conditions as specified below:

   1. NT-Pro BNP \> 8500 pg/mL, and/or
   2. NYHA Class IIIb or IV functional class
4. History of other malignancy that could affect compliance with the protocol or interpretation of results.

   Patients with a history of curatively treated basal or squamous cell carcinoma of the skin, in situ carcinoma of the cervix, breast cancer, or Hodgkin's Lymphoma are generally eligible. Patients with a malignancy that has been treated, but not with curative intent, will be excluded, unless the malignancy has been in remission without treatment for ≥ 2 years prior to enrollment.
5. Evidence of other clinically significant uncontrolled condition(s) including, but not limited to, uncontrolled systemic infection (viral, bacterial, or fungal).
6. Patients on renal replacement therapy
7. Patients with HIV who are not on HAART or those with active hepatitis A, B, or C infection.
8. Planned stem cell transplant during the first 6 cycles of protocol therapy are excluded. Stem cell collection during the first 6 cycles of protocol therapy is permitted, as per investigators' discretion.
9. Known hypersensitivity to any of the agents
10. Patients who are receiving any other investigational agent concurrently.

Where this trial is running

New York, New York

• Columbia University Irving Medical Center — New York, New York, United States (Recruiting)

Study contacts

• Study coordinator: Central Nurse Navigator, RN

Conditions Amyloid Light-chain Amyloidosis; Untreated AL Amyloidosis; untreated light chain amyloidosis; light chain amyloidosis; AL Amyloidosis