Daratumumab for PRCA after HCT: study and practical considerations from the EBMT Transplant Complications Working Party
Blood Cancer Journal, vol. 15, pp. 106
Abstract
Pure red cell aplasia (PRCA) is a relevant complication after ABO-mismatched allogeneic hematopoietic cell transplantation (HCT). No standard treatment exists, and practice is heterogenous. In this study, we took advantage of an international collaboration to describe characteristics and outcomes of patients receiving daratumumab for PRCA following first allogeneic HCT. We identified 45 patients meeting these criteria (median patient age, 56 years). The median time from HCT to PRCA was 55 days (IQR, 36-116) and all patients were transfusion-dependent at time of daratumumab start. Daratumumab was first-line treatment in 16 patients (36%), most patients (67%) received daratumumab intravenously, and median time from PRCA diagnosis and daratumumab start was 88 days (IQR, 59-219). Incidence of transfusion independence was 69% (95% confidence interval [CI], 52-80%) at 6 months and 80% (95% CI, 62-90%) at 12 months. Incidences of hemoglobin and reticulocyte recoveries were respectively 56 and 78% at 6 months and 65 and 83% at 12 months. Survival at 12 months was 81%, and of 8 deaths, 7 were GVHD- or infection-related. One death was associated with hemolytic anemia. This is the first international and largest study on the use of daratumumab for PRCA after allogeneic HCT, showing high response rates superior to that reported for other treatments. Seven incidents of severe adverse events (mostly infections) underscore the need for close monitoring, proactive management, and comparative studies to determine the role for daratumumab for PRCA. Last, based on these data and a comprehensive literature review, we provide practical consideration for modern PRCA treatment.
Authors 30
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Nico Gagelmann corresponding
University Medical Center Hamburg-Eppendorf
Affiliation as printed
University Medical Center Hamburg-Eppendorf, Hamburg, Germany. nico.gagelmann@posteo.de
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University Medical Center Utrecht
Affiliation as printed
Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
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Inserm · Sorbonne Université · Hôpital Saint-Antoine · Centre de Recherche Saint-Antoine
Affiliation as printed
EBMT Paris Study Unit, INSERM UMR-S 938, Sorbonne University, Hôpital Saint Antoine, Paris, France
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Inserm · Sorbonne Université · Hôpital Saint-Antoine · Centre de Recherche Saint-Antoine
Affiliation as printed
EBMT Paris Study Unit, INSERM UMR-S 938, Sorbonne University, Hôpital Saint Antoine, Paris, France
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Affiliation as printed
Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Edgar Jost Aachen
Affiliation as printed
University Hospital Aachen, Aachen, Germany
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Affiliation as printed
RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russian Federation
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Affiliation as printed
Hospital Santa Creu i Sant Pau, Barcelona, Spain
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Università Cattolica del Sacro Cuore
Affiliation as printed
Universita Cattolica S. Cuore, Rome, Italy
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University Medical Center Utrecht
Affiliation as printed
Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
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Affiliation as printed
Nottingham City Hospital, Nottingham, UK
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Affiliation as printed
Universitaet Tuebingen, Tuebingen, Germany
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Universitair Ziekenhuis Leuven · KU Leuven
Affiliation as printed
University Hospital Gasthuisberg, Leuven, Belgium
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University Hospital Schleswig-Holstein
Affiliation as printed
University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Centre Hospitalier Universitaire de Bordeaux · Hôpital Cardiologique du Haut-Lévêque
Affiliation as printed
CHU Bordeaux, Hopital Haut-Leveque, Pessac, France
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Affiliation as printed
RVI Newcastle, Newcastle, UK
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Azienda Ospedaliera San Gerardo
Affiliation as printed
Ospedale San Gerardo, Monza, Italy
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University Medical Center Groningen
Affiliation as printed
University Medical Center Groningen, Groningen, Netherlands
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University Medical Center Hamburg-Eppendorf
Affiliation as printed
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Affiliation as printed
University of Milano, Milano, Italy
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Gruppo Italiano per il Trapianto di Midollo Osseo
Affiliation as printed
Secretary and Italian National BMT Registry - GITMO, Bergamo, Italy
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Complejo Hospitalario de Salamanca
Affiliation as printed
Hospital Clínico, Salamanca, Spain
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Clinica Universidad de Navarra
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Clínica Universitaria de Navarra, Pamplona, Spain
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Institut Català d'Oncologia · Duran i Reynals Hospital
Affiliation as printed
Institut Catalá d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
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Affiliation as printed
Christie Hospital Manchester, Manchester, UK
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Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo
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H SS. Antonio e Biagio, Alessandria, Italy
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Universitair Ziekenhuis Leuven · KU Leuven
Affiliation as printed
University Hospital Gasthuisberg, Leuven, Belgium
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Charité-CVK, University Medicine Berlin, Berlin, Germany
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Affiliation as printed
RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russian Federation
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Affiliation as printed
University Hospital Centre Rijeka and School of Medicine, University of Rijeka, Rijeka, Croatia
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