**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Foteini Theodorakakou, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece

**Main Body of the Abstract**
Background: Cardiac biomarkers are the strongest prognosticators in AL; inclusion of dFLC added granularity but these tools were developed in a different era.
Aim: To evaluate Mayo 2004 and Mayo 2012 in the recent era.
Methods: We analyzed 417 AL patients with data available for both Mayo 2004 (European modification to include stage-3B) and Mayo 2012.
Results: Per Mayo 2004, 60(14%), 187(45%), 81(19%) and 89(21%) were stage-1/-2/-3A/-3B and per Mayo 2012, 79(19%), 88(21%), 122(29%), 128(31%) patients were -I/-II/-III/-IV. Among Mayo 2012 stage-IV, 16(12%) were Mayo 2004 stage-2, 46(36%) -3A and 66(52%) -3B. Primary therapy was bortezomib-based in 331(79%) and daratumumab-containing in 95(23%); 171(41%) patients received daratumumab at any line. Five-year OS for stages-1,-2,-3A,-3B was 84%, 48%, 42% and 13%, with no significant  difference for stages-2 & -3A (p=0.176), and for stages-I,-II,-III and -IV was 77%, 59%, 33% and 30%, with no significant difference between stages-III and -IV(p=0.150). First-line daratumumab improved outcomes across Mayo 2004 stage -2 and -3A and Mayo 2012 stage -I,-II & -III. Use of daratumumab at any line of therapy improved OS across all Mayo 2012 stages and among Mayo 2004 stages -2,-3A and -3B.  Mayo 2004 and Mayo 2012 performed similarly (AUCs:0.656 and 0.618, respectively), however, Mayo 2004 stage-3B identifies a group of extremely poor prognosis, even among Mayo 2012-IV, independently of use of daratumumab.
Conclusion: cardiac dysfunction drives prognosis but new therapies blurred the boundaries among stages in both Mayo 2004 and 2012. Clinical trial design should account for the impact of new therapies.



**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Foteini Theodorakakou, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece

**Main Body of the Abstract**
**Background:** Cardiac biomarkers are the strongest prognosticators in AL; inclusion of dFLC added granularity but these tools were developed in a different era.
**Aim:** To evaluate Mayo 2004 and Mayo 2012 in the recent era.
**Methods:** We analyzed 417 AL patients with data available for both Mayo 2004 (European modification to include stage-3B) and Mayo 2012.
**Results:** Per Mayo 2004, 60(14%), 187(45%), 81(19%) and 89(21%) were stage-1/-2/-3A/-3B and per Mayo 2012, 79(19%), 88(21%), 122(29%), 128(31%) patients were -I/-II/-III/-IV. Among Mayo 2012 stage-IV, 16(12%) were Mayo 2004 stage-2, 46(36%) -3A and 66(52%) -3B. Primary therapy was bortezomib-based in 331(79%) and daratumumab-containing in 95(23%); 171(41%) patients received daratumumab at any line. Five-year OS for stages-1,-2,-3A,-3B was 84%, 48%, 42% and 13%, with no significant  difference for stages-2 & -3A (p=0.176), and for stages-I,-II,-III and -IV was 77%, 59%, 33% and 30%, with no significant difference between stages-III and -IV(p=0.150). First-line daratumumab improved outcomes across Mayo 2004 stage -2 and -3A and Mayo 2012 stage -I,-II & -III. Use of daratumumab at any line of therapy improved OS across all Mayo 2012 stages and among Mayo 2004 stages -2,-3A and -3B.  Mayo 2004 and Mayo 2012 performed similarly (AUCs:0.656 and 0.618, respectively), however, Mayo 2004 stage-3B identifies a group of extremely poor prognosis, even among Mayo 2012-IV, independently of use of daratumumab.
**Conclusion:** cardiac dysfunction drives prognosis but new therapies blurred the boundaries among stages in both Mayo 2004 and 2012. Clinical trial design should account for the impact of new therapies.



Re-evaluation of Mayo 2004 and Revised Mayo 2012 staging in patients with AL amyloidosis in the era of new therapies PA117 (#268)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.