What options are available for patients with relapsed/refractory AL amyloidosis after Dara-CyBorD, other than clinical trial?

No great answers, unfortunately. Lenalidomide still tends to make me a bit nervous in AL amyloidosis, as does carfilzomib in patients with known cardiac involvement. But pom-based regimens are an option, or carfilzomib-based in the appropriate population.

If the patient's BMBx shows t(11;14) by FISH, as it often does in AL amyloidosis, venetoclax is a great option albeit off-label. Two retrospective studies of this are shown here: Sidiqi et al., PMID 32393733 and Premkumar et al., PMID 33431806.

In the larger BELLINI study of venetoclax in patients with t(11;14) MM, the big caution is to be aggressive with infectious prophylaxis including even fluoroquinolones. But apart from that, the responses are quite impressive!