Leukoencephalopathy During Daratumumab-Based Therapy: A Case Series of Two Patients with Multiple Myeloma.
Syeda Saba KareemNeena ViswanathanSolmaz SahebjamNam D TranTyra GatewoodKatherine TobonRachid BazYolanda PiñaKenneth H ShainSepideh MokhtariPublished in: OncoTargets and therapy (2022)
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.
Keyphrases
- multiple myeloma
- end stage renal disease
- newly diagnosed
- white matter
- monoclonal antibody
- blood brain barrier
- multiple sclerosis
- stem cells
- traumatic brain injury
- ejection fraction
- diabetic rats
- drug induced
- risk assessment
- bone marrow
- mesenchymal stem cells
- physical activity
- cell therapy
- patient reported outcomes
- case report
- brain injury
- smoking cessation