多発性骨髄腫患者におけるダラツムマブ皮下投与時の有害事象に対するジフェンヒドラミンとレボセチリジン前処置の比較

抄録

Subcutaneous daratumumab DARA-SC is superior to intravenous daratumumab with a significantly shorter treatment time for multiple myeloma. To prevent infusion reaction (IR) during DARA-SC, oral diphenhydramine, a first-generation antihistamine, has been used in the phase Ⅲ clinical trial and following clinical settings. We recently substituted diphenhydramine with levocetirizine, a second-generation antihistamine, to diminish antihistamine-induced sedation in our regimens for daratumumab.

In this study, we aimed to retrospectively compare the prevention of IR and rate adverse events between diphenhydramine and levocetirizine. We retrospectively analyzed the clinical records of patients in whom DARA-SC treatment was introduced for the first time from August 1st, 2021 to July 31, 2022, at Keio University Hospital.

For the first period, 7 and 24 patients were treated with diphenhydramine and levocetirizine, respectively. Neither patient experienced IR. Two out of 7 patients experienced drowsiness by diphenhydramine while only one of 24 patients experienced it by levocetirizine (P = 0.125). Five and one patients initially treated with diphenhydramine were switched to levocetirizine upon the second and third periods of DARA-SC treatment, respectively. After the switching, their drowsiness was reduced.

In conclusion, levocetirizine was considered more beneficial than diphenhydramine to prevent IR with a lower rate of drowsiness.