Daratumumab

How it works

It binds CD38 expressed highly on myeloma cells and triggers cell death through complement-dependent cytotoxicity, antibody-dependent cellular cytotoxicity and phagocytosis, as well as direct apoptotic and immunomodulatory effects.

Prescribing in practice

• Infusion-related reactions are common, particularly with the first infusion, so pre-medication with corticosteroid, antipyretic and antihistamine is required and infusion should be given with appropriate monitoring and resuscitation facilities.
• CD38 binding to red cells interferes with indirect antiglobulin (Coombs) testing, so type and screen the patient before starting and inform the transfusion laboratory.
• Reactivation of hepatitis B can occur, so screen for hepatitis B before treatment and consider antiviral prophylaxis and herpes zoster prophylaxis.

Monitoring

Monitor full blood count for cytopenias, observe closely during and after infusions for reactions, and screen for viral reactivation before and during therapy.

Counselling the patient

• Report fever, chills, breathlessness or throat tightness during or after an infusion immediately.
• Carry a card noting you have received this antibody, as it can interfere with blood-matching tests for several months.
• Tell the team about any signs of infection such as fever, cough or cold sores.

Evidence & guidelines

Use in multiple myeloma is supported by NICE technology appraisals and pivotal trials such as POLLUX and CASTOR demonstrating improved progression-free survival when added to standard regimens.