Daratumumab: A Review in Newly Diagnosed Systemic Light Chain Amyloidosis

Serum free light chain level-based and non-fixed cycle daratumumab treatment strategy for patients with light chain amyloidosis

BACKGROUND

In recent years, daratumumab (DARA) has gained widespread use in the treatment of systemic light chain (AL) amyloidosis. In this study, we assessed the efficacy and safety of a DARA treatment strategy based on serum free light chain (sFLC) levels and non-fixed cycles.

METHODS

The study included 123 patients with Al amyloidosis who received DARA at our center between July 2020 and September 2023. All patients received the standard DARA treatment (16 mg/kg weekly for four weeks) during the first course. Subsequent treatments were adjusted based on sFLC levels and the physician's judgment.

RESULTS

The results demonstrated an impressive overall hematologic response rate (ORR) of 94.3%, with a hematologic very good partial response (VGPR) and complete response (CR) rate of 84.5%. Median time to best hematologic response was 1 months. Cardiac and renal response rates were 39.3% and 60.3%, respectively. Thirty patients experienced grade 1/2 infusion-related reactions after the first infusion. The rate of grade 3/4 adverse events was 21%. The most common adverse events of grade 3 or 4 were pulmonary infection (6.5%), neutropenia and lymphocytopenia (5.7%), elevated transaminases (1.6%), acute kidney injury (1.6%). After a median follow-up of 13 months (range 1-38), The 1-year OS and PFS estimates were 96.5% and 84.4%, respectively.

CONCLUSION

These findings indicate that the sFLC levels based and non-fixed cycle DARA strategy is an efficacious and safe treatment strategy in both newly diagnosed and relapsed/refractory AL amyloidosis.

Removal efficiency of antineoplastic drug cyclophosphamide by hypochlorous acid

Hypochlorous acid (HClO), one of the major reactive oxygen species, is obtained by electrolyzing a sodium chloride solution. HClO is a safe and effective disinfectant and decomposing agent widely used as an alternative to sodium hypochlorite (NaClO). In this study, the authors aimed to evaluate the safety and efficiency of HClO generated by electrolyzing sodium chloride as a decontaminant. Cyclophosphamide (CPA), an antineoplastic drug, was selected as the model drug, and various solvents (HClO, NaClO, etc.) were compared to identify the solvents that could react with and efficiently decompose CPA. To identify a solvent that efficiently decomposes CPA, the CPA concentration was measured using liquid chromatography with photodiode array detection. When either NaClO or HClO was used, the CPA concentration decreased, and a peak corresponding to 3-chloro CPA, identified by mass spectrometry, was detected. Furthermore, to investigate the reversibility of the reaction between CPA and ClO-, ClO- was removed from the reaction solution using solid-phase extraction, resulting in the previously decreased CPA concentration returning to nearly its original level. Occupational exposure to antineoplastic drugs poses a significant risk to worker health. This study's results suggest that CPA can be replaced by 3-chloro CPA when HClO is used as the wiping solvent like NaClO, thereby reducing occupational exposure from wiping. Future studies should investigate the wiping and degradation efficiencies of other anti-cancer agents. Occupational exposure to anti-cancer drugs can be significantly reduced by integrating various mitigation measures, thereby contributing to a safer work environment for healthcare professionals.

Safety of daratumumab in the real-world: a pharmacovigilance study based on FAERS database

BACKGROUND

Daratumumab is widely used in multiple myeloma (MM) and light chain amyloidosis (AL amyloidosis). The purpose of this study was to identify adverse event (AE) signals for daratumumab through the FDA Adverse Event Reporting System (FAERS) database to assess its safety in a large sample of people.

METHODS

Based on data from the FAERS database, three disproportionality analysis methods were used to mine AE signals for daratumumab, including reporting odd ratio (ROR), proportional reporting ratio (PRR), and bayesian configuration promotion neural network (BCPNN).

RESULTS

A total of 9220 AE reports with daratumumab as the primary suspect drug were collected, containing 23,946 AEs. Within these reports, 252 preferred terms (PT) levels, 73 high level term (HLT) levels and 11 system organ class (SOC) levels of AE signals were detected, along with some new AEs. Most AEs occurred within the first month after drug administration.

CONCLUSION

Our findings were consistent with the results of established studies that daratumumab has a good safety profile. The newly identified AEs are of concern and prospective clinical studies are needed to confirm whether they are causally related to daratumumab. This study provided an early warning for the safe use of daratumumab and also provided guidance for further safety studies.

Real world data on light chain cardiac amyloidosis: Still a delayed diagnosis

Cardiac amyloidosis (CA) represents a myocardial disorder developed by fibril deposition of a heterogeneous group of misfolding proteins. Despite being rare, a high clinical index of suspicion and novel advanced diagnostic methods seem to facilitate its early recognition. Currently nine types of cardiac amyloidosis have been described with AL and ATTR being the most common. Light chain amyloidosis (AL) is a life-threatening disease, resulting from clonal plasma cells that produce amyloidogenic light chain fragments causing organ damage including the heart. Morbidity and mortality of these patients is strongly associated with the severity of cardiac involvement. Thus, early and precise diagnosis is crucial for prompt treatment initiation. In this study, we retrospectively analyzed data of 36 consecutive patients who were diagnosed with AL amyloidosis and treated in our center over the past 15 years. Heart involvement was present in 33 (92%) of them while 76% had severe cardiac disease as of stage IIIa and IIIb, according to the Mayo2004/European staging system. Almost one third of these patients experienced an early death occurring the first five months of diagnosis. To capture everyday clinical practice, we provide details on clinical presentation, diagnostic challenges, and outcome of these patients.