Daratumumab‐based therapy for patients with monoclonal gammopathy of renal significance

• Published in: British journal of haematology Vol. 193; no. 1; pp. 113 - 118
• Main Authors: Kastritis, Efstathios, Theodorakakou, Foteini, Roussou, Maria, Psimenou, Erasmia, Gakiopoulou, Charikleia, Marinaki, Smaragdi, Gatou, Anastasia, Fotiou, Despina, Migkou, Magdalini, Kanellias, Nikolaos, Eleutherakis‐Papaiakovou, Evangelos, Malandrakis, Panagiotis, Dialoupi, Ioanna, Ntanasis‐Stathopoulos, Ioannis, Kostopoulos, Ioannis V., Terpos, Evangelos, Gavriatopoulou, Maria, Dimopoulos, Meletios A.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.04.2021
• Subjects: CD38; Dialysis; Epidermal growth factor receptors; estimated glomerular filtration rate; Flow cytometry; Glomerular filtration rate; Hematology; Immunoglobulins; Minimal residual disease; Monoclonal gammopathy; monoclonal gammopathy of renal significance; Nerve growth factor; Proteinuria; Renal function; Response rates; Toxicity; CD38; monoclonal gammopathy of renal significance; estimated glomerular filtration rate; proteinuria
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.17052

Summary Treatment of the plasma cell clone in monoclonal gammopathy of renal significance (MGRS) is necessary in order to reduce toxic immunoglobulin load to the kidneys and salvage renal function. There are limited data on the use of daratumumab in patients with MGRS. We summarize our experience with the use of daratumumab‐based therapy in 25 MGRS patients, 12 of whom were previously untreated. The median follow‐up of the cohort is 14 months. The best overall haematologic response in evaluable patients was complete response (CR) in five (22%), very good partial response (VGPR) in five (22%) and partial response (PR) in seven (30%) patients for an overall response rate of 74%. Two of five patients in CR and two patients with initially detectable clones, but non‐measurable immunoglobulins, had undetectable minimal residual disease (MRD) with next‐generation flow cytometry (NGF) after therapy. Haematologic response rate for previously untreated patients was 83% vs. 69% for previously treated and for daratumumab combinations it was 91% vs. 64%, and with CR/VGPR 82% vs. 29%, compared to daratumumab monotherapy. At six months, 12/22 (55%) patients not on dialysis achieved a reduction of proteinuria >30%, of at least 0·5 g/24 h, without an estimated glomerular filtration rate (eGFR) reduction. The toxicity was mild and predictable. In conclusion, daratumumab‐based therapy is a new option for patients with MGRS.