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Severe cytomegalovirus enterocolitis developing following daratumumab exposure in three patients with multiple myeloma
Author(s) -
Lavi Noa,
Okasha Doaa,
Sabo Edmond,
Oren Ilana,
Benyamini Noam,
BarYoseph Haggai
Publication year - 2018
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13164
Subject(s) - medicine , daratumumab , bortezomib , multiple myeloma , cytomegalovirus , immunosuppression , enterocolitis , immunology , oncology , gastroenterology , viral disease , herpesviridae , human immunodeficiency virus (hiv)
Objectives The risk of cytomegalovirus ( CMV ) reactivation in multiple myeloma ( MM ) patients treated with bortezomib‐based induction regimens is increased following autologous stem cell transplantation ( ASCT ). There is paucity of data regarding the risk of CMV infections in MM patients who did not receive bortezomib and ASCT . Methods We herein report three cases of heavily pretreated MM patients, receiving daratumumab‐containing combination regimens, in whom ASCT had been performed long ago and who recently developed severe CMV ‐related gastrointestinal disease. Results All the three patients had a prolonged CMV disease course requiring a long‐term antiviral treatment. All the patients suffered from CMV colitis. One patient had concurrent CMV duodenitis and another patient had a concurrent CMV retinitis. Conclusion Novel myeloma treatments prolong patient survival and more patients with profound immunosuppression following multiple lines of therapies are seen in clinical practice. These patients may present with opportunistic infections that were rare in the past. Our findings suggest a possible association between daratumumab therapy (in combination with other immunosuppressive therapies) and severe CMV gastrointestinal disease. A longer follow‐up is needed to explore long‐term side effects of novel agents like daratumumab in newly diagnosed as well as heavily pretreated MM patients.