II. Indications

III. Mechanism

  1. CD38 Antigen (Cyclic ADP Ribose Hydrolase)
    1. Cell surface enzyme expressed primarily on WBCs (esp. plasma cells, as well as B Cells, T Cells, Natural Killer Cells)
    2. CD38 catalyzes the reaction catalyzes the synthesis of cyclic ADP-Ribose (cADPR) from NAD+ and ADP-Ribose
      1. Cyclic ADP-Ribose is integral to intracellular Calcium level regulation
    3. CD38 also activates a second messenger system in cell signaling
      1. Appears to regulate cytotoxic response of activated Natural Killer Cells
  2. CD38 Monoclonal Antibody (e.g. Daratumumab)
    1. Monoclonal Antibody directed against the cell surface Glycoprotein CD-38
    2. Used to target Multiple Myeloma and plasma Leukemia cells
    3. Binding triggers anti-tumor cytotoxicity

IV. Medications

  1. Daratumumab (Darzalex) injection solution

V. Dosing

  1. See other references for disease specific dosing protocols
  2. Premedicate with Corticosteroids, antipyretics and Antihistamines

VI. Adverse Effects

  1. Infusion Reactions
  2. Cytopenia
    1. Neutropenia
    2. Thrombocytopenia
  3. Other common adverse effects
    1. Peripheral Neuropathy
    2. Nausea
    3. Altered bowel habits (Constipation, Diarrhea)
    4. Peripheral Edema
    5. Dyspnea

VII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters, Pregnancy category X)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count with differential and Platelet Count

VIII. Drug Interactions

  1. Interferes with Red Blood Cell cross-matching and Antibody screening
    1. Type and screen prior to treatment

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