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[Listeria meningitis during daratumumab/bortezomib/dexamethasone therapy in a patient with multiple myeloma]
Tomoki Fujii1,2, Nobuhiro Ohno1, Shinsuke Kitahara1,2
1Department of Hematology, Kantoh Rosai Hospital.
Abstract:
An 88-year-old woman was diagnosed with multiple myeloma received third-line chemotherapy, including DBd (daratumumab [DARA], bortezomib, and dexamethasone [Dex]), and the myeloma was in remission. Sulfamethoxazole/trimethoprim (ST) prophylaxis was discontinued because the dose of Dex was reduced to 20 mg every 4 weeks after 21 cycles of DBd. After 28 cycles of DBd, altered consciousness with fever ensued, and she was referred to the emergency department where Listeria monocytogenes (LM) meningitis was diagnosed. CD38 inactivation is associated with increased LM susceptibility. In patients on Dara-based chemotherapy, antibiotic prophylaxis should be considered using ST, which has activity against Listeria.
Insights
A multiple myeloma patient developed Listeria meningitis after discontinuing antibiotic prophylaxis during daratumumab-based chemotherapy. This highlights the need for continued prophylaxis, such as sulfamethoxazole/trimethoprim, during CD38-targeted therapy.
Area of Science:
- * Hematology
- * Infectious Diseases
- * Oncology
Background:
- * Multiple myeloma is a hematologic malignancy treated with chemotherapy regimens.
- * Daratumumab (DARA), a CD38-targeted therapy, is used in multiple myeloma treatment.
- * Prophylaxis with sulfamethoxazole/trimethoprim (ST) is common during chemotherapy.
Observation:
- * An 88-year-old woman with multiple myeloma received third-line daratumumab, bortezomib, and dexamethasone (DBd) chemotherapy.
- The patient achieved remission, and dexamethasone dose was reduced, leading to discontinuation of ST prophylaxis.
- After 28 cycles of DBd, the patient presented with fever and altered consciousness.
Findings:
- * The patient was diagnosed with Listeria monocytogenes (LM) meningitis.
- * CD38 inactivation, a mechanism of daratumumab, is linked to increased susceptibility to LM infections.
- Discontinuation of ST prophylaxis coincided with the LM meningitis diagnosis.
Implications:
- * Patients undergoing CD38-targeted therapy, like daratumumab, may be at increased risk for Listeria infections.
- * Antibiotic prophylaxis, specifically with agents like ST that target Listeria, should be strongly considered during daratumumab-based chemotherapy.
- Close monitoring for infections is crucial in immunocompromised patients receiving novel cancer therapies.
