Slogrove, Olivia, and Wight, Joel (2026) Effective management of daratumumab-induced cytopenias with hematopoietic stem cell infusion in relapsed/refractory multiple myeloma: a case report. Leukemia and Lymphoma, 67 (4). pp. 943-946.

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Abstract

[Extract] Plasma cell myeloma (PCM) invariably relapses after initial therapy [Citation1]. CD38 is highly expressed on plasma cells and represents a therapeutic target [Citation1]. Daratumumab is a humanized anti-CD38 monoclonal antibody used in relapsed/refractory-PCM (RR-PCM) [Citation2]. Additionally, CD38 is expressed at varying levels on hematopoietic stem cells (HSCs) [Citation3]. It is well reported that when used in first-line regimes, Daratumumab combination therapy yields slower CD34+ HSC mobilization [Citation4]. In maintenance therapy, it has been associated with a higher occurrence of Grade ≥3 thrombocytopenia, neutropenia, and anemia [Citation5–7].

Toxicities associated with Daratumumab may be more pronounced in patients experiencing early relapse after autologous stem cell transplant (AuSCT) due to cumulative therapy-related myelosuppression and poor engraftment. Hematologic toxicity may limit the delivery of effective salvage therapies. Here we report two cases of progressive, severe and treatment-limiting cytopenias seen with daratumumab-based therapy in early RR-PCM post AuSCT, that were ameliorated with HSC “top up.”

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