Treatment of Multiple Myeloma With Daratumumab in a Kidney Transplant Patient

Abstract

Clinical Features: A middle-aged man with history of kidney transplantation was diagnosed with multiple myeloma (MM); he was treated with cyclophosphamide, bortezomib, and dexamethasone (CyBorD) for induction therapy. However, a repeat bone marrow biopsy after treatment revealed 10% clonal plasma cell involvement. Given residual disease, his treatment regimen was changed to daratumumab, bortezomib, and dexamethasone in an attempt to achieve minimal residual disease. Therapeutic Challenge: Daratumumab was recently approved for treatment of relapsed or refractory MM; there are no data regarding the safety and effectiveness in solid organ transplant patients. Solution: Our patient was treated with a daratumumab-based regimen for MM. His renal function was monitored closely along with donor-specific antibody to assess for risk of graft rejection. His renal function remained stable with minimal proteinuria and negative donor-specific antibody during the treatment course.

A case of treatment‐resistant membranous nephropathy associated with graft versus host disease successfully treated with daratumumab

“…[4][5][6] Daratumumab is an anti-CD38 human monoclonal antibody that received accelerated approval for the treatment of multiple myeloma in 2015. 7 Demonstrated to be safe for multiple myeloma patients with renal failure [8][9][10] and with kidney transplants, 11 its utility in other antibody-mediated diseases affecting the kidney has been subsequently probed. Examples include membranoproliferative glomerulonephritis with monoclonal immunoglobulin deposits, [12][13][14] immunoglobulin light-chain amyloidosis with renal involvement, [15][16][17] and antibody-mediated rejection of kidney transplants.…”