Hi Sophiesgran. That’s interesting: both academically and because I also started on Dara in January 2023!
I hadn’t heard of mylodisplasia. I asked AI (specifically Google Gemini):
“Long-term exposure to daratumumab itself is not typically considered a direct cause of myelodysplastic syndrome (MDS). However, the broader picture involves several important nuances:
Combination Therapies: Daratumumab is almost always given alongside other myeloma medications, such as lenalidomide, alkylating agents (like melphalan or cyclophosphamide), or autologous stem cell transplantation (ASCT). Certain traditional chemotherapy agents and immunomodulatory drugs (especially lenalidomide, particularly after alkylators or stem cell transplants) carry a well-documented risk of secondary primary malignancies, including MDS.
Underlying Disease and Prior Treatments: Multiple myeloma itself, along with the bone marrow environment in myeloma patients who have received multiple prior lines of therapy, carries a baseline risk for developing marrow disorders such as MDS.
Clinical Trial Observations: In clinical trials where daratumumab is added to backbone regimens (e.g., Daratumumab + Lenalidomide + Dexamethasone), cases of MDS or secondary cancers are tracked. While MDS is occasionally reported in these trial populations, research indicates this risk is primarily driven by exposure to lenalidomide, alkylating agents, or prior radiation/chemotherapy rather than daratumumab’s specific mechanism of action (which is a targeted CD38 monoclonal antibody).
Long-Term Safety Monitoring: Daratumumab can cause prolonged cytopenias (low blood counts, such as neutropenia or thrombocytopenia), which can mimic some signs of bone marrow stress. Your care team routinely monitors full blood counts and will investigate with a bone marrow biopsy if persistent unexplained drops in blood counts occur.
If you or your oncology team are concerned about persistent low blood counts or changes in your bone marrow function, discussing a formal bone marrow evaluation is the standard next step.”
davidainsdale.
