[Cheryl G]

Small study re: Darzalex & risk of infections

by Cheryl G on Thu Feb 14, 2019 5:07 pm

Hi everyone,

This study was recently published. I thought it might be of interest to patients being treated with Darzalex, or about to start treatment with the drug.

Keep in mind that this is a single-institution study with a small number of patients. Also, accord­ing to the abstract, the infections that were observed occurred only in patients who experienced only a partial response (PR) or worse. So patients who respond well to the drug may be less likely to develop an infection.

Link to article:

Nahi, H., et al, "Infectious complications and NK cell depletion following daratumumab treatment of multiple myeloma," PLoS One. Feb 13, 2019 (full text of article)

Abstract:

Treatment with daratumumab (dara), a monoclonal anti-CD38 antibody of IgG1 sub­type, is effective in patients with multiple myeloma. However, dara also im­pairs the cellular immunity, which in turn may lead to higher susceptibility to infections. The exact link be­tween immune im­pairment and infectious complications is unclear. In this study, we re­port that nine out of 23 patients (39%) with progressive multiple myeloma had infectious com­plications after dara treat­ment. Five of these patients had viral infections, two devel­oped with bacterial infections and two with both bacterial and viral infections. Two of the viral infections were exogenous, i.e. acute respiratory syncytial virus (RSV) and human meta­pneumo­virus (hMPV), while five con­sisted of reactivations, i.e. one herpes simplex (HSV), 1 varicella-zoster (VZV) and three cyto­megalo­virus (CMV). Infections were solely seen in patients with partial response or worse. Assessment of circulat­ing lympho­cytes indi­cated a selective de­pletion of NK cells and viral reactiva­tion after dara treatment, however this finding does not exclude the multiple components of viral immune-surveillance that may get disabled during this mono­clonal treatment in this patient cohort. These results suggest that the use of antiviral and antibacterial prophylaxis and screening of the patients should be considered.