Use of daratumumab in therapy of patients with newly diagnosed multiple myeloma complicated by dialysis-dependent kidney failure: literature review and clinical observation

Abstract

   Multiple myeloma (MM) is a B-cell lymphoproliferative disorder. Its morphological substrate is plasma cells producing monoclonal immunoglobulin. Monoclonal light chains damage nephrons leading to development of acute kidney failure (AKF) which can be diagnosed at MM onset, recurrence, or progression. Dialysis-dependent kidney failure (DDKF) is associated with worse prognosis and decreased overall survival. Currently, the standard of MM therapy complicated by moderate and severe AKF is programs including bortezomib. According to the results of completed trials, achievement of hematological response plays the main role in AKF resolution, therefore, the use of new highly effective regimens of antitumor drug therapy is recommended. Despite the results of large clinical trials showing the effectiveness of daratumumab in therapy of patients with MM, data on its use in patients with newly diagnosed MM complicated by DDKF who are candidates for autologous hematopoietic stem cell transplant are limited. A case of daratumumab therapy (as monotherapy and in combination with lenalidomide, dexamethasone) of a 38-year-old female patient with MM complicated by DDKF and significant adverse events developed during previous short-term treatment with bortezomib is presented. The achieved hematological response (partial remission, absence of minimal residual disease), satisfactory somatic condition, as well as favorable daratumumab safety profile allowed to consider the patient for autologous hematopoietic stem cell transplant and increased the probability of improved renal response with subsequent cancellation of hemodialysis.