Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Eur J Haematol. 2018 May;100(5):494-501. doi: 10.1111/ejh.13046. Epub 2018 Mar 25.
Daratumumab is a promising new antimyeloma agent. We report a single center "real-world" series of multiple myeloma (MM) and amyloidosis (AL) patients treated with daratumumab.
Forty-one patients were included: 7 second-line MM, 30 heavily pretreated (median number of therapies of 5) advanced MM, and 4 with AL.
Second-line patients and advanced AL showed high rate of durable overall responses. However, advanced MM patients had a dismal prognosis with an overall response rate (ORR) of 36%, and a short median progression-free and overall survival of 2.3 and 6.6 months, respectively. Responses were particularly poor in patients with extramedullary plasmacytomas. Neither the addition of another agent to daratumumab nor changing to the next line of therapy produced significant durable responses in this patient population. Flow cytometry analysis demonstrated that CD38 expression level was not predictive of response. We show that CD38 expression dynamics by a commercially available anti-CD38 antibody after daratumumab administration was hindered by competitive binding of daratumumab.
Responses to daratumumab and combinations in patients with advanced MM, particularly with extramedullary disease, are low and short-lived, stressing the administration of this agent should be early in the course of the disease.
达雷妥尤单抗是一种很有前途的新型骨髓瘤治疗药物。我们报告了单中心“真实世界”系列多发性骨髓瘤（MM）和淀粉样变性（AL）患者接受达雷妥尤单抗治疗的情况。
共纳入 41 例患者：7 例二线 MM，30 例经大量预处理（中位数治疗次数为 5 次）的晚期 MM，4 例 AL。
二线患者和晚期 AL 患者表现出持久的总体缓解率高。然而，晚期 MM 患者预后极差，总体缓解率（ORR）为 36%，无进展生存期和总生存期的中位数分别为 2.3 和 6.6 个月。骨髓外浆细胞瘤患者的缓解情况尤其差。在该患者人群中，将其他药物与达雷妥尤单抗联合使用或改用下一线治疗并不能产生显著持久的缓解。流式细胞术分析表明，CD38 表达水平与反应无关。我们表明，在达雷妥尤单抗给药后，一种商业上可用的抗 CD38 抗体对 CD38 表达的动态检测受到达雷妥尤单抗竞争结合的阻碍。
晚期 MM 患者，特别是有骨髓外疾病的患者，对达雷妥尤单抗和联合治疗的反应率低且持续时间短，这强调了应在疾病早期使用该药物。
