Daratumumab

How it works

It binds CD38 expressed highly on myeloma cells and kills them through antibody-dependent cellular cytotoxicity, complement-dependent cytotoxicity, phagocytosis and direct apoptotic effects, with additional immunomodulatory actions.

Prescribing in practice

• Infusion- or injection-related reactions are common, so pre-medication and appropriate monitoring with administration are required.
• CD38 binding to red cells interferes with indirect antiglobulin (Coombs) testing, so type and screen the patient before starting and inform the transfusion laboratory.
• It is given with corticosteroid and other anti-myeloma agents according to the chosen regimen, and reactivation of hepatitis B should be considered.

Monitoring

Monitor full blood count and for infusion-related reactions; ensure blood bank is aware because of interference with cross-matching.

Counselling the patient

• Tell future healthcare providers you have received this medicine, as it can affect blood compatibility tests for some time.
• Report any reaction during or after the infusion, and any signs of infection.
• A subcutaneous formulation may be used in place of intravenous infusion.

Evidence & guidelines

Multiple phase 3 trials (including CASTOR, POLLUX and MAIA) established daratumumab combinations in myeloma, and it is recommended by NICE in defined settings.