Experience of Daratumumab in Six Patients With Multiple Myeloma and Kidney Failure

Abstract

Purpose Daratumumab, a monoclonal anti-CD38 antibody, has been administered for relapsed refractory multiple myeloma (RRMM). The Pollux and Castor trials proved its efficacy, yet excluded patients with advanced-stage renal disease. Therefore, available experience in these patients is limited. Here, we aimed to emphasize the safety of daratumumab in 6 patients with kidney disease. Methods Six patients with RRMM diagnoses and renal impairment were included. Their mean ± standard deviation age was 63.6 ± 8.38 years. Three, two, and one patient(s) had immunoglobulin (Ig) G kappa, lambda light chain, and IgA lambda MM, respectively. All patients received 4 to 6 lines of anti-MM therapy before daratumumab treatment. Five had chronic kidney disease and 1 was admitted to the hospital with acute kidney injury due to myeloma relapse. Daratumumab was administered to all patients with close follow-up. Results Following treatment with daratumumab, kidney function was improved in 1 patient. In 1 patient, the glomerular filtration rate was slightly decreased and hemodialysis was initiated. In 2 patients already receiving hemodialysis, their dependency on hemodialysis continued. No adverse reactions were recorded. One patient achieved complete remission and 4 patients achieved very good partial remission. Conclusion Daratumumab can be administered safely, with improvements in kidney function possible in some patients. Studies involving larger patient groups are required to obtain more accurate data.

Clinical and economic burden of medicare beneficiaries with multiple myeloma and renal impairment: An observational study

“…[12] Additionally, some evidence has shown improved clinical outcomes with DARA in patients with relapsed/refractory MM (RRMM) with RI. [13]…”

“…[14] Factors such as cast nephropathy, light chain deposition disease, or amyloidosis may contribute to the presence of RI. [15] Due to major developments in the therapeutic landscape, [7,13,16,17] the care of MM patients with RI has evolved into a complicated decision-making process, resulting in a wide range of therapy patterns. However, RI majorly affects therapeutic choices in patients with MM because of their limited ability to tolerate the treatment (dose reduction, duration of treatment, and doublet vs triplet treatment regimen).…”