Daratumumab
| 證據等級: L5 | 預測適應症: 10 個 |
目錄
Daratumumab: From Active Multiple Myeloma to Indolent Plasma Cell Myeloma
One-Sentence Summary
Daratumumab is an anti-CD38 monoclonal antibody used in the treatment of active (symptomatic) multiple myeloma. The TxGNN model predicts it may also be effective for indolent plasma cell myeloma (smouldering multiple myeloma), an earlier stage of the same disease spectrum, but this is currently supported by only 1 tangentially-related clinical trial and 5 publications (mostly case reports and reviews), with no trial yet testing daratumumab directly in this population.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Active (symptomatic) multiple myeloma (per drug mechanism data; not a TGA-registered indication — see below) |
| Predicted New Indication | Indolent Plasma Cell Myeloma (Smouldering Multiple Myeloma) |
| TxGNN Prediction Score | 98.13% |
| Evidence Level | L4 |
| Australia Market Status | Not Marketed |
| Number of ARTG Entries | 0 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
A formal, sourced mechanism-of-action record for daratumumab is not available in this evidence pack (data gap). Based on the information that is available, daratumumab is known to be an anti-CD38 monoclonal antibody. CD38 is highly expressed on the surface of plasma cells, and one of the retrieved publications (PMID 28915615) directly demonstrates CD38 expression within the myeloma bone marrow niche — including in patients with indolent monoclonal gammopathy — providing a theoretical basis for anti-CD38 immunotherapy in this setting.
Indolent plasma cell myeloma (smouldering multiple myeloma) and daratumumab’s established indication of active multiple myeloma sit on the same disease spectrum, with smouldering myeloma representing the asymptomatic precursor state. This is a biologically plausible, adjacent-indication extension rather than a novel mechanistic hypothesis — the malignant plasma cell clone targeted by daratumumab is present at both disease stages, differing mainly in tumour burden and end-organ damage.
However, none of the retrieved evidence directly tests daratumumab therapy in an indolent/smouldering myeloma population — the available literature describes disease biology, case presentations, and CD38 pathobiology rather than treatment outcomes. This gap should temper confidence in near-term clinical applicability.
Clinical Trial Evidence
| Trial Number | Phase | Status | Enrolment | Key Findings |
|---|---|---|---|---|
| NCT04136756 | Phase 1 | Completed | 30 | Dose-escalation/expansion study of NKTR‑255 (an IL‑15 receptor agonist) in relapsed/refractory haematological malignancies; daratumumab subcutaneous was used as a combination partner in one treatment arm. This trial evaluates NKTR‑255, not daratumumab, and does not specifically enrol an indolent/smouldering myeloma population — it is only weakly relevant (assessed relevance grade: C, disease-population overlap only). |
No trial directly evaluating daratumumab monotherapy or combination therapy in indolent plasma cell myeloma was identified in this evidence pack.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 41571958 | 2026 | Review | Nature Reviews Clinical Oncology | Overview of diagnosis, risk stratification and management of smouldering multiple myeloma; describes disease trajectory but does not evaluate daratumumab specifically. |
| 28915615 | 2017 | Review (mechanistic) | Oncotarget | Characterises CD38 expression on bone marrow cells in multiple myeloma and indolent monoclonal gammopathy, providing the mechanistic rationale for anti-CD38 (daratumumab) immunotherapy and its potential effects on osteoclast formation. |
| 34514307 | 2021 | Review/Case report | European Heart Journal – Case Reports | Discusses imaging in a patient with concurrent cardiac amyloid light-chain amyloidosis; tangential — does not address daratumumab use or indolent myeloma treatment. |
| 40257478 | 2025 | Case Report | Annals of Hematology | Describes paraneoplastic leukocytoclastic vasculitis as a rare initial presentation of smouldering (IgG kappa) myeloma; disease-presentation focus, not treatment. |
| 32736600 | 2020 | Case Report | BMC Gastroenterology | Reports a colonic mass revealing disseminated crystal-storing histiocytosis secondary to indolent multiple myeloma; describes a disease complication, not daratumumab treatment. |
Australia Market Information
Daratumumab currently has no entries on the Australian Register of Therapeutic Goods (ARTG) — the drug is not marketed in Australia, so no product-level market table can be produced from this evidence pack.
Cytotoxicity
Daratumumab is an oncology therapeutic (anti-CD38 monoclonal antibody used in plasma cell malignancies), so this section applies.
| Item | Content |
|---|---|
| Cytotoxicity Classification | Immunotherapy — anti-CD38 monoclonal antibody (not a conventional cytotoxic chemotherapy agent) |
| Myelosuppression Risk | Please refer to the Product Information (PI) warnings and precautions |
| Emetogenicity Classification | Please refer to the Product Information (PI) warnings and precautions |
| Monitoring Items | Please refer to the Product Information (PI) warnings and precautions |
| Handling Protection | Please refer to the Product Information (PI) warnings and precautions |
Safety Considerations
Please refer to the TGA-approved Product Information (PI) for safety information. Key warnings, contraindications and drug-drug interaction data are not available in this evidence pack (interaction query returned “not found”), and this represents a Blocking data gap preventing initial safety screening.
Conclusion and Next Steps
Decision: Hold
Rationale: Evidence is limited to mechanistic/preclinical rationale (L4) — no identified trial tests daratumumab directly in an indolent/smouldering multiple myeloma population, and the one retrieved trial (NCT04136756) evaluates a different investigational agent. Combined with a Blocking data gap on TGA-equivalent safety labelling and the drug’s unmarketed status in Australia (0 ARTG entries), the evidence base does not yet support progression beyond a research question.
To proceed, the following is needed:
- TGA-approved Product Information / equivalent safety labelling (warnings, contraindications) — currently a Blocking data gap
- Verified mechanism-of-action documentation (e.g. from DrugBank) — currently a data gap
- Prospective clinical trial evidence testing daratumumab specifically in an indolent/smouldering multiple myeloma population
- Drug-drug interaction data (current query returned no results)
- ARTG registration status confirmation or an import/access pathway if Australian use is being considered
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.