Education Reassures Patients With MM Receiving Subcutaneous Daratumumab

While subcutaneous daratumumab with hyaluronidase-fihj (Darzalex Faspro) is considered widely tolerable and reduces chair time for patients being treated for multiple myeloma, oncology nurses should be aware when administering the injection that patients may be intimidated by the needle size and may need some reassurance, according to Stephanie Mompoint, APRN, a research advanced practice nurse at the University of Miami.

Mompoint recommends talking through what to expect with patients, from the injection volume to potential adverse events (AEs). As Mompoint emphasized, subcutaneous daratumumab can cause a rash at the injection site, and while systemic reactions are not always expected of subcutaneous injections, they are still possible.

She advises nurses to keep an eye out for signs of systemic reactions such as chills during and after administration of daratumumab. When educating patients on AEs, nurses should encourage patients to report persistent redness that spreads so that they can receive topical treatment to reduce irritation.

Transcript:

Daratumumab has been approved as a monoclonal antibody drug treatment of multiple myeloma. It’s given as 1 infusion, together with daratumumab and hyaluronidase.

You’re going to have that reaction from the patient seeing the needle when they see the volume that’s going to be inserted. It’s [essential to] reassure them and let them know that the premedications will help with reaction, and, as the nurse, to be alert for possible immediate systemic reactions.

Now, just because the drug is given subcutaneously, that doesn’t mean that the systemic reactions are not going to happen, like fevers [and] chills. It’s important to talk to the patient, and you yourself be on the lookout for that. If your patient starts to have chills, even while you’re doing the subcutaneous injection, you have to stop the injection and give the patient time to settle down, take their temperature, do their vitals, and call the provider if extra medication is needed.

I’ve gotten questions about that, and it’s important, because imagine that the patient’s going to start a new therapy, and they know it’s subcutaneous, but a lot of time you don’t think about the quantity of some subcutaneous [injections] that’s going to be administered. The more the patient knows, the more at ease they will be, and the more alert they will be also. Then they know what to look out for.

One simple thing [to do] is let them know, “Yes, you’re going to start with a needle stick. And it might sting at the beginning.” And then as we’re pushing more and we’re having conversation, educating them that the site might be a little bit swollen, and when you go home, you might find a rash there.

“Now it’s OK to have some redness, but if that redness continues to spread, you need to let us know, because something as simple as some topical steroid could help with that.” It goes back to education, to letting them know, and reassuring them, and explaining things in a way that they will understand.

This transcript has been edited for clarity and conciseness.