From Amyloidosis Foundation A recent 15-year analysis from ashpublications.org reveals a significant decline (71%) in autologous stem cell transplantation (ASCT) for AL amyloidosis as Dara-CyBorD (daratumumab, cyclophosphamide, bortezomib, dexamethasone) replaced CyBorD (cyclophosphamide, bortezomib, dexamethasone) as the preferred upfront therapy. The study indicates ASCT is now reserved for patients with relapsed/refractory disease, suboptimal responses to Dara-CyBorD, or high bone marrow plasma cell burden. Key Findings: Shift from ASCT to Dara-CyBorD: . The introduction of Dara-CyBorD led to a substantial decrease in ASCT utilization, with a 71% reduction observed between the CyBorD-dominated era (2010-2019) and the Dara-CyBorD era (2020-2024). Increased Pre-ASCT Therapy: . In the more recent cohort, a higher percentage of patients received pre-ASCT induction therapy, with Dara-CyBorD being the prevalent choice. Improved Response Rates: . Dara-CyBorD demonstrated superior hematologic response rates compared to CyBorD, contributing to its reduced reliance on ASCT as a salvage therapy. ASCT for Refractory/High-Risk Cases: . ASCT is now primarily utilized for patients who don't respond adequately to Dara-CyBorD, patients with relapsed or refractory disease, or those with a "myeloma phenotype" characterized by a high plasma cell burden in the bone marrow. Patient Profile Changes: . The study also noted some changes in the characteristics of patients undergoing ASCT in the later period, including older age and a higher baseline bone marrow plasma cell burden.