Cytomegalovirus Reactivation in a Patient With Extensively Pretreated Multiple Myeloma During Daratumumab Treatment

Recommendations for vaccination in multiple myeloma: a consensus of the European Myeloma Network

“…Limited evidence suggests that patients on lenalidomide maintenance show an enhanced antibody response from the immune stimulatory effects induced by IMiDs [80], but a recent study in patients on lenalidomide maintenance was unable to confirm this [63]. In patients on daratumumab therapy, a similar vaccination response was reported compared to patients receiving non-daratumumab containing therapy [78]. Patients with scheduled chemotherapy should be vaccinated at least 2 weeks before initiation of chemotherapy [5], upon achievement of best response, 3-6 months after completion of chemotherapy or autologous transplantation, and 6-24 months after allogeneic transplantation.…”

“…A small series of patients with RRMM treated with daratumumab showed a similar vaccination response to PCV13 and PPV23, Haemophilus influenza, and seasonal influenza compared to patients receiving non-daratumumab containing regimes [ 78 ]. Similar responses likely are to be expected for other CD38 monoclonal antibodies.…”

Hepatitis B virus reactivation in a myeloma patient with resolved infection who received daratumumab-containing salvage chemotherapy

“…DARA is an IgG1 kappa monoclonal antibody targeting CD38 that that is expressed not only in myeloma cells, but also in non-malignant T cells, natural killer (NK) cells, B cells, and plasma cells. 13,14 Recently, DARA-containing chemotherapy was reported to be associated with CMV infection, 3,4,6 suggesting that cellular immunity was suppressed in some patients who received DARA-containing chemotherapy. More recently, a retrospective study assessing circulating lymphocytes revealed that DARA can selectively deplete NK cells, which may lead to viral reactivation.…”

“…2 However, DARA treatment may be associated with an increased risk of viral infection; specifically, cytomegalovirus (CMV) reactivation occurs in patients with multiple myeloma after DARA administration. [3][4][5][6] Hepatitis B virus (HBV) reactivation is also a potentially fatal complication of DARA treatment. 7,8 Rituximab, an anti-CD20 monoclonal antibody, plus steroid combination chemotherapy is a risk factor in patients with resolved HBV infection, defined as being seronegative for hepatitis B surface antigen (HBsAg), but seropositive for antibodies against hepatitis B core antigen (anti-HBc) and/or antibodies against HBsAg (anti-HBs).…”

EBV-related lymphoma after long-term daratumumab treatment: a case report

“…Indeed, at the time of diagnosis of the EBV-related lymphoma, a lymphopenia was present (0.53 × 10 9 /l), and stopping daratumumab together with 4 doses of rituximab cured the lymphoma, comparable to PTLD. In line with this immune-suppressive mechanism is the described symptomatic cytomegalovirus (CMV) reactivation in a patient during daratumumab monotherapy 15 and severe CMV-related gastro-intestinal disease in three patients receiving daratumumab 16 .…”