Monitoring Immune Health With Subcutaneous Daratumumab

While the use of subcutaneous daratumumab and hyaluronidase-fihj (Darzalex Faspro) in patients with multiple myeloma is well tolerated, oncology nurses and advanced practice providers (APPs) should be aware of patients’ history and monitor their immune systems over the course of treatment, explained Chad Robertson, PA-C, a senior physician assistant at the Mount Sinai Tisch Cancer Center in New York, New York.

Subcutaneous daratumumab is broadly tolerated by patients, but Robertson explained that over time, the CD38-targeting monoclonal antibody can wear down a patient’s immune system, leading to a greater vulnerability to infection.

Additionally, he emphasized that pneumonia or upper respiratory infections are signals to be aware of in a patient’s history. If patients have such a history, Robertson explained that it may be appropriate to dose reduce or cease treatment after a few years of treatment, especially in patients with negative minimal residual disease (MRD) status.

Robertson also added that subcutaneous daratumumab has a lesser effect on bone marrow, resulting in fewer changes in blood counts.

Transcript

The best part about this medication is it’s so well tolerated. The one thing that we do watch for, from a long-term perspective, is that it can wear down your immune system. By wearing down on your immune system, you become a little bit more susceptible to infections, especially respiratory infections, according to what we have seen.

There is that history of pneumonia or upper respiratory infections [to look out for]. You might consider spreading out the dosing or reducing it, especially if it’s in a patient who has reached MRD-negative status or is very well controlled. It may be beneficial to take it off for after a few years.

It doesn’t work on the bone marrow, the way that [lenalidomide; Revlimid] would, where you might see some thrombocytopenia or some anemia. When you’re dealing with a hematologic issue, any treatment is going to bring down counts in some way. But [subcutaneous daratumumab is] not something that makes [as much of a negative] impact like some of the other drugs do.

This transcript has been edited for clarity and conciseness.