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. 2025 Aug 13;6(4):e70122.
doi: 10.1002/jha2.70122. eCollection 2025 Aug.

Concurrent Immunoglobulin Light Chain and Transthyretin Cardiac Amyloidosis Patient Treated With Daratumumab and Tafamidis: A Case Report

Taiki Nishihara  1 , Yawara Kawano  2 , Masayoshi Tasaki  3   4 , Ayuko Naito  2 , Hiromichi Yuki  5 , Yasuhiro Nagayoshi  1 , Seiji Takashio  6 , Nao Nishimura  2 , Mitsuharu Ueda  3 , Kenichi Tsujita  6 , Jun-Ichirou Yasunaga  2
Affiliations

Concurrent Immunoglobulin Light Chain and Transthyretin Cardiac Amyloidosis Patient Treated With Daratumumab and Tafamidis: A Case Report

Taiki Nishihara et al. EJHaem. .

Abstract

Immunoglobulin light chain (AL) and wild-type transthyretin (ATTRwt) amyloidosis, while sharing similar clinical presentations, require distinct treatments. We report a rare case of a 75-year-old man with heart failure diagnosed with concurrent AL and ATTRwt cardiac amyloidosis. Immunohistochemistry and liquid chromatography-tandem mass spectrometry confirmed both AL and ATTR amyloid deposits in the heart. The patient was safely and effectively treated with daratumumab-based chemotherapy followed by tafamidis. This case underscores the necessity of precise amyloid typing for tailored therapy, suggesting sequential daratumumab and tafamidis as a viable strategy for this complex overlap. Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.

Keywords: AL amyloidosis; ATTR amyloidosis; case report; daratumumab; tafamidis.

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Conflict of interest statement

Yawara Kawano has received honoraria from Janssen Pharmaceuticals Inc. outside the submitted work. Masayoshi Tasaki has received grants from Pfizer outside the submitted work. Mitsuharu Ueda has received grants, personal fees, and non‐financial support from Pfizer outside the submitted work. Seiji Takashio has received honoraria from Pfizer outside the submitted work. Kenichi Tsujita has received honoraria from Pfizer outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Histopathological staining of specimens obtained via endomyocardial biopsy. Congo red stained specimen visualized by light microscopy (A) and cross‐polarized light microscopy (B). Immunohistochemical stained specimen for expression of transthyretin (C) and lambda light chains (D).
FIGURE 2
FIGURE 2
Change in dFLC and NT‐ProBNP levels according to treatments. dFLC: difference between involved and uninvolved free light chains, NT‐ProBNP: N‐terminal pro‐brain natriuretic peptide, DaraCyBorD: daratumumab, cyclophosphamide, bortezomib and dexamethasone
See this image and copyright information in PMC

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