Graft-versus-host disease in multiple myeloma patients treated with daratumumab after allogeneic transplantation

Abstract Introduction Allogeneic hematopoietic cell transplantation (alloHCT) represents an adoptive immunotherapy strategy for eliciting a graft-versus-myeloma the effect for high risk or relapsed multiple myeloma (MM). AlloHCT recipients are at risk for graft vs host disease (GVHD) and associated increases in morbidity and mortality. Daratumumab, an anti-CD38 IgG1 kappa humanized monoclonal antibody, used for treatment of MM. Daratumumab also affects CD38+ non-myeloma cells, including T cells, which mediate GVHD. The use of daratumumab following alloHCT has not been well described and its potential impact on GVHD is unknown. Methods In a multicenter, retrospective study we evaluated incidence of GVHD in 34 patients with relapsed MM treated with daratumumab after alloHCT. Results Overall response to daratumumab (PR or better) was 41% (95%CI: 24% to 59%). A total of five patients (15%) developed acute GVHD after daratumumab, no chronic GVHD events were observed after daratumumab. One of these 5 patients had a history of chronic GVHD and developed a flare of acute GVHD during daratumumab therapy. The remaining 4 patients did not have a preceding history of GVHD before daratumumab. Conclusions Our results demonstrate that the incidence of GVHD after daratumumab is low and did not result in increased exacerbation of GVHD in patients with prior history of GVHD.