Kareem Syeda Saba, Viswanathan Neena, Sahebjam Solmaz, Tran Nam D, Gatewood Tyra, Tobon Katherine, Baz Rachid, Piña Yolanda, Shain Kenneth H, Mokhtari Sepideh
Malignant Hematology Department, Moffitt Cancer Center, Tampa, FL, USA.
Neuro-Oncology Department, Moffitt Cancer Center, Tampa, FL, USA.
Onco Targets Ther. 2022 Sep 6;15:953-962. doi: 10.2147/OTT.S365657. eCollection 2022.
Leukoencephalopathy in the setting of multiple myeloma (MM) is a rare demyelinating condition, with few reported cases in literature. Daratumumab is a CD38 targeted monoclonal antibody that has been widely used for the management of MM. In the absence of central nervous system (CNS) disease, many medication-induced leukoencephalopathy cases reported with MM, including daratumumab-induced, are associated with progressive multifocal leukoencephalopathy (PML) and John Cunningham (JC) virus. Currently, there are no reported cases of daratumumab-induced leukoencephalopathy among patients without CNS involvement or PML. We discuss 2 patients who developed leukoencephalopathy while receiving daratumumab-based therapy without evidence of PML or CNS disease. Both patients had baseline MRIs without significant white matter changes before daratumumab-based therapy. Patients began experiencing neurological deficits about 6 to 8 months after daratumumab-based therapy initiation. One patient passed away before being assessed for improvement of symptoms with daratumumab cessation. The second patient had some stabilization of symptoms after cessation; however, the leukoencephalopathy remained irreversible. As the class of anti-CD38 monoclonal antibodies expands in MM therapy, we highlight a potential treatment complication and the importance of detecting leukoencephalopathy early among patients receiving anti-CD38 therapy. We recommend vigilant monitoring of any new or worsening neurological symptoms to avoid serious complications of irreversible leukoencephalopathy.
多发性骨髓瘤（MM）背景下的白质脑病是一种罕见的脱髓鞘疾病，文献报道的病例很少。达雷妥尤单抗是一种靶向CD38的单克隆抗体，已广泛用于MM的治疗。在没有中枢神经系统（CNS）疾病的情况下，MM报告的许多药物性白质脑病病例，包括达雷妥尤单抗引起的，都与进行性多灶性白质脑病（PML）和约翰·坎宁安（JC）病毒有关。目前，在没有CNS受累或PML的患者中，尚无达雷妥尤单抗引起白质脑病的报道。我们讨论了2例在接受基于达雷妥尤单抗的治疗时发生白质脑病的患者，这些患者没有PML或CNS疾病的证据。两名患者在接受基于达雷妥尤单抗的治疗前，基线MRI显示没有明显的白质变化。患者在开始基于达雷妥尤单抗的治疗后约6至8个月开始出现神经功能缺损。一名患者在评估停用达雷妥尤单抗后症状是否改善之前死亡。第二名患者在停药后症状有所稳定；然而，白质脑病仍然是不可逆的。随着抗CD38单克隆抗体类药物在MM治疗中的应用不断扩大，我们强调了一种潜在的治疗并发症以及在接受抗CD38治疗的患者中早期检测白质脑病的重要性。我们建议密切监测任何新出现或加重的神经症状，以避免不可逆白质脑病的严重并发症。
