AL amyloidosis: 2026 so far

Real-world studies added support alongside ANDROMEDA's survival and organ-worsening advantages.

In the months covered, several real-world (observational) comparisons and cohorts linked daratumumab-based first therapy to faster and deeper hematologic responses (blood responses measured by light chains) than approaches without daratumumab. Some datasets also reported higher early heart and kidney responses. The randomized evidence described in May came from the phase 3 ANDROMEDA trial (a late-stage randomized trial comparing treatments) in 388 newly diagnosed patients. ANDROMEDA reported a higher complete response (59.5% vs 19.2), a faster time to response, and at about 5 years median follow-up, better overall survival and longer time without major organ worsening. Heart and kidney responses were reported as about 2 to 3 times higher. Later reports added observational details: MRD negativity (no measurable disease left by sensitive testing) and early response milestones (for example, 3-month blood/heart response) were associated with longer survival in real-world cohorts. Even with daratumumab-based therapy, very advanced cardiac disease still carried substantial early risk. In practical terms, the months covered consistently linked daratumumab-based first treatment with deeper blood control and higher organ response rates, while also showing that baseline heart severity and depth of response still strongly shaped outcomes.

Research covered in: January 2026, February 2026, March 2026, May 2026, June 2026, July 2026, August 2026

BCMA approaches expanded, while safety centered on infections and CRS.

In the months covered, multiple small series, retrospective cohorts, and pooled analyses reported that BCMA-targeted approaches (treatments aimed at the BCMA protein on plasma cells) -- including bispecific antibodies (drugs that link immune cells to cancer cells) and CAR T-cell therapies (a personalized immune-cell treatment) -- often produced rapid, deep hematologic responses in relapsed/refractory AL amyloidosis. Some cohorts also reported heart and kidney responses within months. Safety was a major theme. Cytokine release syndrome (CRS, an immune overreaction that can cause fever and low blood pressure) was discussed repeatedly, and serious infections were common. One real-world teclistamab cohort linked immunoglobulin replacement therapy (IVIG, giving back infection-fighting antibodies) with a lower risk of severe and fatal infections. Separately, a single-center retrospective study in September reported daratumumab monotherapy in relapsed AL amyloidosis, with a hematologic response in 72.5% and a heart response in 42.4% of evaluable patients; deeper responses were associated with longer time to progression. Overall, the relapse reports in the months covered paired high response rates with a clear need for close infection and CRS monitoring and supportive care in the studied groups.

Research covered in: March 2026, April 2026, June 2026, July 2026, August 2026, September 2026

Supportive heart-drug signals emerged, but causality stayed uncertain.

Two large observational analyses in the months covered connected commonly used heart-failure medicines to outcomes in amyloid-related heart failure, including AL. In a matched real-world analysis, SGLT2 inhibitor use (a type of heart and diabetes medicine) was associated with lower death rates and fewer hospitalizations over 12 months. In a propensity-matched database study, ACE inhibitor/ARB/ARNi use (blood-pressure and heart medicines that affect the renin-angiotensin system) was linked to lower all-cause mortality over 3 years in AL amyloidosis, but not in ATTR amyloidosis. That ACEi/ARB/ARNi analysis also reported more hospitalizations and more kidney/electrolyte side effects, including acute kidney injury, hyperkalemia, and dizziness, showing a tradeoff pattern in the observational data. Another supportive-care report described a non-sedating antihistamine premedication strategy associated with less early drowsiness around subcutaneous daratumumab in a prospective observational comparison. Taken together, the months covered linked supportive heart and symptom-management choices with differences in outcomes and symptoms, without establishing cause and effect, while also showing that the evidence was non-randomized and included reported side-effect tradeoffs.

Research covered in: March 2026, July 2026, September 2026

Multiple studies clarified delayed and incomplete organ improvement timelines.

Several reports in the months covered linked deeper hematologic responses to better outcomes. At the same time, organ recovery -- especially cardiac recovery -- was often slower, less common, and sometimes incomplete even after strong blood responses. A phase 2 study (a mid-stage trial testing whether a treatment works and is safe) in newly diagnosed advanced cardiac AL reported that about half reached complete hematologic response by longer follow-up, while heart responses were less common and tended to appear over time. A large cardiac cohort found that cardiac biomarker complete response was uncommon and typically happened many months after blood response (median about 21 months). Case reports and observational studies also showed mismatch between blood and organ changes: some patients had major blood-marker improvement without stabilization of advanced cardiac physiology, while others had gradual improvement in symptoms or imaging over extended follow-up. In the months covered, this meant response tracking repeatedly relied on both blood markers and organ-specific measures over time, because they may not improve on the same schedule.

Research covered in: March 2026, April 2026, June 2026, August 2026, September 2026

Routine labs and biopsy/imaging features were tied to outcomes.

In January, two multicenter liver studies supported change in alkaline phosphatase (a routine liver blood test) over months as a workable hepatic response measure. In these studies, liver response aligned with better survival, and in one analysis simpler response definitions performed well. Later months added kidney-focused prognostic detail. Retrospective biopsy studies linked specific kidney pathology features (findings seen on kidney tissue under the microscope) -- such as PAS-positive deposits, higher CD68-positive macrophage infiltration, and mixed injury patterns -- to higher dialysis risk and/or shorter survival. One cohort also connected SAP scan amyloid regression (SAP scan, an imaging test that can track amyloid deposits) -- more common with complete hematologic response -- to longer kidney survival. A separate kidney-response study in May linked early deep hematologic response and lower renal stage to a higher chance of a 'deep' kidney response over time. Overall, the months covered increasingly connected practical lab tests and kidney tissue/imaging features with longer-term organ outcomes, while the evidence remained observational.

Research covered in: January 2026, May 2026, July 2026