Horigome Yuichi, Kamata Hirotoshi, Michishita Yusuke, Yokoyama Maki, Tadera Noriyuki, Hayama Kei, Suzuki Takahiro
Department of Hematology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan.
Int J Hematol. 2025 Mar 31. doi: 10.1007/s12185-025-03980-8.
Combination therapy with daratumumab, lenalidomide, and dexamethasone (D-Rd) has greatly improved outcomes for transplant-ineligible newly diagnosed multiple myeloma (TIE-NDMM). Effective management of herpes zoster (HZ) and other infections is critical to maximize therapeutic benefit and to maintain treatment continuity. However, antiviral prophylaxis for HZ in TIE-NDMM patients receiving D-Rd has unclear efficacy, and is currently not covered by health insurance in Japan. In this study, we retrospectively analyzed the incidence of HZ in 40 TIE-NDMM patients treated with D-Rd. Nine patients (22.5%) developed HZ at a median period of 10.7 months (range, 0.4-34.2 months) after starting D-Rd. The cumulative HZ incidence at 12, 24, and 36 months was 13.3%, 19.5%, and 28.6%, respectively. Development of HZ was not associated with patient characteristics, disease characteristics, or hematologic response. Our data indicate a high incidence of HZ in TIE-NDMM patients receiving D-Rd, and we anticipate that Japanese health insurance should soon cover prophylactic treatment of HZ in D-Rd.
达雷妥尤单抗、来那度胺和地塞米松联合疗法（D-Rd）极大地改善了不适于移植的新诊断多发性骨髓瘤（TIE-NDMM）患者的治疗效果。有效管理带状疱疹（HZ）和其他感染对于最大化治疗益处及维持治疗连续性至关重要。然而，接受D-Rd治疗的TIE-NDMM患者中，针对HZ的抗病毒预防疗效尚不明确，且目前在日本医保中未涵盖。在本研究中，我们回顾性分析了40例接受D-Rd治疗的TIE-NDMM患者中HZ的发生率。9例患者（22.5%）在开始D-Rd治疗后的中位时间10.7个月（范围0.4 - 34.2个月）出现HZ。12、24和36个月时的HZ累积发生率分别为13.3%、19.5 %和28.6%。HZ的发生与患者特征、疾病特征或血液学反应无关。我们的数据表明接受D-Rd治疗的TIE-NDMM患者中HZ发生率较高，并且我们预计日本医保应尽快涵盖D-Rd治疗中HZ的预防性治疗。
