Daratumumab in combination with proteasome inhibitors, rapidly decreases polyclonal immunoglobulins and increases infection risk among relapsed multiple myeloma patients: a single center retrospective study
| Autor: | Dan Netanely, Ben-Zion Katz, Ronit Ben-Yzak, Irit Avivi, Shai Levi, Roy Vitkon, Svetlana Trestman, Moshe Mittelman, Yael C Cohen, Tomer Ziv-Baran, Noam Benyamini |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Oncology
medicine.medical_specialty Dara Single Center 03 medical and health sciences 0302 clinical medicine Internal medicine hypogammaglobinemia Medicine Diseases of the blood and blood-forming organs infections Multiple myeloma Original Research IVIG biology business.industry Daratumumab Retrospective cohort study Hematology daratumumab medicine.disease multiple myeloma Proteasome Polyclonal antibodies 030220 oncology & carcinogenesis biology.protein Antibody RC633-647.5 business 030215 immunology |
| Zdroj: | Therapeutic Advances in Hematology, Vol 12 (2021) Therapeutic Advances in Hematology |
| ISSN: | 2040-6215 |
| Popis: | Background: Daratumumab (Dara) is generally well tolerated, but is associated with increased risk of infection. Methods: We investigated hypogammaglobinemia occurrence in different Dara-based regimens. Multiple myeloma (MM) patients were treated with ⩾2 cycles of Dara-based therapy during 2016–2020, mainly for relapsed/refractory disease. Data on patient characteristics, treatment regimens, polyclonal IgG (poly-IgG) and uninvolved free light chain (Un-FLC) levels during treatment, as well as predictors for hypogammaglobinemia and predictors for infections, were evaluated retrospectively. Results: A total of 84 patients, median age 67.2 years, were included. Dara, mainly as ⩾2 line therapy (88.1%, n = 74), was combined with immunomodulating drugs (IMiDs) (53%), proteasome inhibitors (PIs) (15%), IMiDs-PIs (11%), or dexamethasone only (21%). Median treatment duration was 13 months. Median Poly-IgG levels at 0, 2, and 4 months were 7.1 g/l, 4.5 g/l, and 4 g/l, respectively, and remained low throughout treatment. Lower poly-IgG pre-Dara ( p = 0.001) and Dara-PIs (±IMiDs) regimen were associated with lower poly-IgG levels at 4 months ( p = 0.03). Only patients treated with Dara monotherapy had partial immune reconstitution, reflected by resumption of IgM levels. Most (85%) patients developed ⩾1 infections, mostly grade 1–2 respiratory (76%). A lower poly-IgG level post Dara (RR = 1.137 p = 0.026) predicted increased risk of any infection. Intravenous immunoglobulin (IVIG) was associated with a significant decrease in all infections. Conclusion: Relapsed MM patients treated with Dara, often experience persistent hypogammaglobinemia, irrespective of responsiveness to treatment. Infections, especially respiratory, are frequent and apparently related to low Poly-IgG levels. IVIG should be considered for reducing infections in these patients. |
| Databáze: | OpenAIRE |
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