![Figure 3. Practical aspects of management of CD38 antibody therapy. The main adverse event associated with CD38 antibodies is the development of IRRs, which may prolong the duration of the CD38 antibody infusion. To prevent development of IRRs, it is important to administer appropriate pre- and postinfusion medication. We typically administer 1 to 3 hours prior to the daratumumab infusion preinfusion prophylaxis consisting of antihistamines (H1 receptor antagonist: eg, 2 mg of clemastine or 25-50 mg of diphenhydramine), acetaminophen (650-1000 mg), and corticosteroids (100 mg of methylprednisolone or equivalent for daratumumab monotherapy [following the second infusion, this can be lowered to 60 mg] and 20 mg of dexamethasone for combination therapy). Furthermore, we give all patients 10 mg of montelukast prior to the first daratumumab infusion. In case the patient experiences an IRR, we also consider montelukast in subsequent infusions. For patients on daratumumab monotherapy, we give as postinfusion medication corticosteroids (20 mg methylprednisolone or equivalent on each of the 2 days following the daratumumab infusion). For patients on daratumumab combination therapy, no additional methylprednisolone as postinfusion medication is needed if dexamethasone is administered the day after the daratumumab infusion as part of the background regimen (otherwise administration of 20 mg of methylprednisolone or equivalent can be considered on the day after the infusion). For patients with a history of chronic obstructive pulmonary disease, consider prescribing short- and long-acting bronchodilators and inhaled corticosteroids. For isatuximab and MOR202, which are currently not approved, we follow the study protocol for pre-and postinfusion prophylaxis. Herpes zoster prophylaxis should be considered in patients treated with CD38-targeted therapy. CD38 antibodies also interfere with laboratory tests such as serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE), which may confound evaluation of response. CD38 antibodies also interfere with routine methods for compatibility testing for blood transfusion. Important management aspects of some other antibody classes are also shown.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/131/1/10.1182_blood-2017-06-740944/4/blood740944f3.jpeg?Expires=1735833894&Signature=xt~s0eSbC6~SYhRtCsr0mvCNMCb8UW-8zN3NbT8D-pT0SvoQi7y2doWbnelz-x6ObhLcmTBKWJ9pm~gxBEdhnovTYnmTUnnMAV-Fx0eK8S4rvsz8I9WFK6Hzh~t1EMt7u6vWgrfHbE-HBbRk3ux0WWttx-pkEC8m92-Q8rn5ymtF07MdzDGjwtq8mzqmzBvdZPSRFmXNcSyAsUdBMRChfkjcpbzChBDpkFI-TD8oEICue-ibPuGOCGBv0dId8lUQRz878wBpoi3NwiRH07VgQmuk1jN8TQRz660O8ynz~NiUicPm6seOer1XobRiwWCxo5shEVNa4vbpsUAt4uxdDg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
Practical aspects of management of CD38 antibody therapy. The main adverse event associated with CD38 antibodies is the development of IRRs, which may prolong the duration of the CD38 antibody infusion. To prevent development of IRRs, it is important to administer appropriate pre- and postinfusion medication. We typically administer 1 to 3 hours prior to the daratumumab infusion preinfusion prophylaxis consisting of antihistamines (H1 receptor antagonist: eg, 2 mg of clemastine or 25-50 mg of diphenhydramine), acetaminophen (650-1000 mg), and corticosteroids (100 mg of methylprednisolone or equivalent for daratumumab monotherapy [following the second infusion, this can be lowered to 60 mg] and 20 mg of dexamethasone for combination therapy). Furthermore, we give all patients 10 mg of montelukast prior to the first daratumumab infusion. In case the patient experiences an IRR, we also consider montelukast in subsequent infusions. For patients on daratumumab monotherapy, we give as postinfusion medication corticosteroids (20 mg methylprednisolone or equivalent on each of the 2 days following the daratumumab infusion). For patients on daratumumab combination therapy, no additional methylprednisolone as postinfusion medication is needed if dexamethasone is administered the day after the daratumumab infusion as part of the background regimen (otherwise administration of 20 mg of methylprednisolone or equivalent can be considered on the day after the infusion). For patients with a history of chronic obstructive pulmonary disease, consider prescribing short- and long-acting bronchodilators and inhaled corticosteroids. For isatuximab and MOR202, which are currently not approved, we follow the study protocol for pre-and postinfusion prophylaxis. Herpes zoster prophylaxis should be considered in patients treated with CD38-targeted therapy. CD38 antibodies also interfere with laboratory tests such as serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE), which may confound evaluation of response. CD38 antibodies also interfere with routine methods for compatibility testing for blood transfusion. Important management aspects of some other antibody classes are also shown.
