Leukoencephalopathy During Daratumumab-Based Therapy: A Case Series of Two Patients with Multiple Myeloma

• Published in: OncoTargets and therapy Vol. 15; pp. 953 - 962
• Main Authors: Kareem, Syeda Saba, Viswanathan, Neena, Sahebjam, Solmaz, Tran, Nam D, Gatewood, Tyra, Tobon, Katherine, Baz, Rachid, Pina, Yolanda, Shain, Kenneth H, Mokhtari, Sepideh
• Format: Journal Article
• Language: English
• Published: Macclesfield Dove Medical Press Limited 30.09.2022; Taylor & Francis Ltd; Dove
• Subjects: Care and treatment; Case reports; Case Series; CD38 antigen; Central nervous system; Chemotherapy; Cognition & reasoning; Coronaviruses; COVID-19; Cytotoxicity; Dehydrogenases; Demyelination; Development and progression; Diagnostic tests; Dysphagia; Hematoma; Immunotherapy; Leukoencephalopathy; Magnetic resonance imaging; Medical research; Medicine, Experimental; Monoclonal antibodies; Multiple myeloma; Neurological diseases; Patients; Peripheral neuropathy; Polymerase chain reaction; Progressive multifocal leukoencephalopathy; Substantia alba; Targeted cancer therapy
• ISSN: 1178-6930; 1178-6930
• DOI: 10.2147/OTT.S365657

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. Keywords: anti-CD38, monoclonal antibody, neurotoxicity, plasma cell disorder, white matter changes, daratumumab, leukoencephalopathy, case report