Summer Updates: More about “dara” …and ideas about what may cause myeloma

In an important paper published recently in the journal Blood, researchers from the Netherlands and Belgium correlate the response to daratumumab (dara), the anti-CD38 monoclonal antibody, to the level of CD38 expression on the myeloma cells and whether or not complement inhibitory proteins (CIPs) CD55 and CD59 emerge with treatment. A separate report in Blood from a joint Danish, Netherlands, Italian, and US team summarizes the findings of a phase I/ II study combining dara with lenalidomide + dexamethasone to show that the combination produces responses in 81% of patients versus approximately 30% with dara alone. These results led to the development of the POLLUX trial, which recently confirmed the approximately 80% response rate for the combo with 78% of patients still in remission at close to 2 years. The results of the combination of dara with bortezomib (Velcade®) and dexamethasone (the CASTOR trial) were reported at ASCO in June this year and have just been published in the New England Journal of Medicine. In this case, the response rate was 82.9% but with shorter follow-up thus far. 

Daratumumab shows great promise in published report today

The major article today in the New England Journal of Medicine is a report  of a study with lead author, Dr. Henk Lokhorst (from VU University Medical center in Amsterdam, Netherlands) which summarizes the phase I – II trials results in 72 patients treated with daratumumab, anti-CD38 therapy.

Is it possible to boost the immune system for myeloma patients?

The answer is a definite maybe! As myeloma evolves, it does so within the complex immune microenvironment of the bone marrow. The most well-known impact is the reduction in normal plasma cells and reductions in normal immunoglobulin production, causing reduced normal gamma globulins as part of the SPEP (serum protein electrophoresis) pattern. But there are many other effects of the disease which result in reduced or abnormal immune responses. The most well-documented feature of myeloma is the reduced ability to fight infections.