Management of infectious risk of daratumumab therapy in multiple myeloma: A consensus-based position paper from an ad hoc Italian expert panel

Race for the Cure: From the Oldest to the Newest Monoclonal Antibodies for Multiple Myeloma Treatment

“…In contrast, there is not yet a universal consensus about anti-bacterial prophylaxis in people receiving anti-CD38, even if grade ¾ pneumonia has been reported as a common adverse event in the safety analysis of data from five phase 3 trials with daratumumab [ 31 ]. An Italian expert panel has recently addressed this issue [ 32 ]. In the agreed position, they recommend prophylaxis against Pneumocystis jirovecii in all patients for the entire duration of treatment with the anti-CD38 if in association with a high-dose steroid, while fluoroquinolone prophylaxis is encouraged during front-line therapy including daratumumab only in patients at high risk for infection identified on the basis of past medical history, age, and tumor burden.…”

Prevention of infections including vaccination strategies in multiple myeloma

“…14,15 Daratumumab and isatuximab reduce B cell function with depletion of plasma cells that can result in severe humoral immunodeficiency, increasing the risk for bacterial infections and virus reactivation. 16 Novel drugs including selinexor, belantamab mafodotin, and bispecific antibodies are also associated with increased risk of infections. Allogeneic transplantation was identified as an important risk factor for infections, but its use is constantly decreasing due to the advent of novel therapies such as CAR-T cells.…”

“…Thalidomide does not increase the risk of infections unless given in combination with dexamethasone, while neutropenia can occur during lenalidomide‐ and particularly during pomalidomide‐based therapy 14,15 . Daratumumab and isatuximab reduce B cell function with depletion of plasma cells that can result in severe humoral immunodeficiency, increasing the risk for bacterial infections and virus reactivation 16 . Novel drugs including selinexor, belantamab mafodotin, and bispecific antibodies are also associated with increased risk of infections.…”

Case report: Unexpected parvovirus B19 infection in a myeloma patient treated with daratumumab

“…Daratumumab is a human anti-CD38 monoclonal antibody (mAb) initially approved in patients with Relapsed/Refractory MM (RRMM) as monotherapy (4) and subsequently in combination with proteasome inhibitors (PIs, Dara-Vd) (5) or with immunomodulatory drugs (IMiDs, Dara-Rd) (6); currently, it is also employed for the treatment of newly diagnosed patients with MM (7,8). The association between daratumumab-containing regimens and the development of infections has been repeatedly investigated (9). Recently, two retrospective real-world studies have focused on infectious complications after daratumumab administration in patients with MM, reporting approximately 40% bacterial, 60% viral and 3% fungal and parasitic infections (10,11).…”

“…Recently, two retrospective real-world studies have focused on infectious complications after daratumumab administration in patients with MM, reporting approximately 40% bacterial, 60% viral and 3% fungal and parasitic infections (10,11). Exogenous viruses such as Respiratory Syncytial Virus or Metapneumovirus, and Herpes Virus reactivations (Cytomegalovirus, VZV and HSV) were the most frequently among viral infections (9). This figure data has been recently confirmed by the data from Food and Drug Administration's Adverse Events Reporting System (FAERS), a pharmacovigilance monitoring database that reported Herpes Zoster as the most common infectious event during daratumumab therapy (25,1%), followed by CMV reactivation (22.0%) (12).…”