Associate professor Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow, Uttar Pradesh, India
Introduction: Plasma cell leukaemia (PCL) is the most aggressive form of plasma cell dyscrasia. Usually It requires VDT-PACE like aggressive Induction chemotherapy. When patient is not fit for VDT –PACE , Daratumumab based Induction therapy is an option.
Methods: We are presenting a case of plasma cell leukaemia treated with Daratumumab based induction Chemotherapy, followed by early autologous transplant
Results: A 48 year old female referred to hematology department from Nephrology ICU, she was admitted to the nephrology ICU with Complaint of oliguria & CCF. She underwent 2 cycles of haemodialysis. On work up the cause of AKI was found to be plasma cell leukaemia. She was having IgG Lambda M band (Qty- 5.8g/dl), Sr Kappa -31, Sr Lambda- 11,000 & Kappa/ lambda ratio of 0.002. Her Myeloma FISH panel was showing t (11; 14) & gain 1q. She was started on DARA-VCD induction, in view of fungal pneumonia at presentation. After 4 cycles of DARA-VCD chemotherapy, she was in VGPR, with M band of 0.2g/dl & Sr Lambda of 7. On pre-transplant workup she was MRD positive, PET negative, with eGFR of 29 ml/min/ 1.73m2, PFT was showing mild restriction. She underwent G-CSF+ Plerixafor mobilization, with CD4 cell count of 3.9x 106 cells/Kg. Mel 140 conditioning was used for conditioning, due to her low eGFR. Febrile neutropenia, & Mucositis (Grade 3-4) was major issues during transplant otherwise she tolerated well. She engrafted for neutrophils on ay 12 & for platelets on day 15. There were no major complications till Day +100; Day +100 Marrow was MRD Negative. She was given 2 cycles of DARA-VCD consolidation & then switched to Dara/Bortezomib based maintenance therapy. She is absolutely fine, currently on Day +180.
Conclusions: Daratumumab based Induction therapy is an important treatment alternative for VDT –PACE chemotherapy for PCL.A randomised control trial should be conducted in more number of patients.
