How it is administered

Daratumumab can be given in two main ways:

• Intravenous (IV) infusion: The medication is diluted and slowly infused into a vein, usually in a hospital or clinic setting. The infusion can take several hours, especially for the first dose, and is given according to a specific schedule that becomes less frequent over time.
• Subcutaneous injection: Daratumumab is also available as a combination with hyaluronidase for subcutaneous (under the skin) injection, usually in the abdomen. This form (often called "Faspro") is injected over 3–5 minutes and is typically more convenient and quicker than IV infusion.

Both forms require pre-medication to reduce the risk of reactions and are administered by healthcare professionals.

How it works

Daratumumab is a type of targeted therapy known as a monoclonal antibody. It works by binding to a protein called CD38, which is found in high amounts on the surface of multiple myeloma cells and some other blood cancer cells.

When daratumumab attaches to CD38, it helps the immune system recognize and destroy these cancer cells in several ways:

• It can directly trigger the death of the cancer cell.
• It marks the cancer cell for destruction by the body's own immune cells (such as natural killer cells).
• It can activate the complement system, another part of the immune response, to attack the cancer cell.

By targeting CD38, daratumumab not only attacks myeloma cells but may also reduce certain immune-suppressing cells, helping the immune system work better against the cancer.

Who Should take it

Daratumumab is used to treat adults with multiple myeloma, a type of blood cancer. It can be given:

• In combination with other medications (such as lenalidomide, dexamethasone, bortezomib, melphalan, prednisone, thalidomide, carfilzomib, or pomalidomide) for newly diagnosed patients or those who have received prior treatments.
• As a single agent (monotherapy) for patients who have already tried several other treatments, including a proteasome inhibitor and an immunomodulatory agent, or whose disease is resistant to these therapies.

It is also approved in combination with other drugs for certain patients with light chain (AL) amyloidosis, another rare blood disorder.

Your doctor will decide if daratumumab is right for you based on your diagnosis, previous treatments, and overall health.

Who should not take it

Daratumumab should not be used by patients who have had a severe allergic or hypersensitivity reaction (such as anaphylaxis) to daratumumab, hyaluronidase (for the subcutaneous form), or any of the other ingredients in the formulation.

It is not recommended for use in pregnant women, as it may harm an unborn baby. Women of childbearing potential should use effective contraception during treatment and for 3 months after the last dose.

Daratumumab is not approved for children, and its safety and effectiveness in pediatric patients have not been established. Patients with certain severe heart conditions (especially in AL amyloidosis) or those with a history of severe infusion or injection reactions should not receive this medication.

Commonly used with

Daratumumab is most often used in combination with other anti-myeloma medications, such as:

• Lenalidomide and dexamethasone
• Bortezomib (with melphalan and prednisone, or with thalidomide and dexamethasone)
• Carfilzomib and dexamethasone
• Pomalidomide and dexamethasone

The choice of combination depends on whether you are newly diagnosed, eligible for stem cell transplant, or have relapsed/refractory disease.

Commonly tested with

Daratumumab has been tested in clinical trials with a variety of other medications for multiple myeloma, including:

• Lenalidomide and dexamethasone
• Bortezomib (with or without melphalan, prednisone, or thalidomide)
• Carfilzomib and dexamethasone
• Pomalidomide and dexamethasone
• Cyclophosphamide and dexamethasone (especially for AL amyloidosis)

These combinations have been studied in both newly diagnosed and previously treated patients, and the results have shown improved outcomes compared to standard therapies alone.