Nursing Management of Subcutaneous Daratumumab at Home: A Safe and Effective Procedure for Frail Patients with Multiple Myeloma
Authors: Emanueli Cippitelli Elisa , Innocenti Vincenza , Perazzini Roberta , Talucci Roberta , Fiorini Alessia , Trapè Giulio , Chavez Maria Gabriela , Agrippino Roberta , Tarnani Michela , Mastini Cristina , Andriani Alessandro , Montanaro Marco , Latagliata Roberto , De Angelis Gioia , Ciambella Silvia 
Published: December 2024

Background: Treatment of Multiple Myeloma (MM) is often difficult due to patient (pts) frailty, bone lesions/fractures that can hinder transport and/or long distance from the hospital. The availability in the Viterbo province of a Domiciliary Hematologic Care Unit (DHCU) allowed to overcome these difficulties Methods: Herein, the nursing experience in 22 patients with MM [M/F 10/12 (45.5/54.5), median age 71.8 years, interquartile range (IQR) 64.3 - 78.8] treated as outpatients with subcutaneous (sc) daratumumab (dara) is reported, as part of the Myel-Home project . The initial 2 dara administrations, either intravenous or sc, were given in hospital to prevent side effects, while subsequent administrations were done as outpatients: the first dara administration as outpatient was done by nurse and physician, while subsequent ones by nurse only Results: The main reasons for the activation of home-care modality by responsible physician were as follows: bone lesions/fractures secondary to MM in 15 pts (68.2%), age &gt; 80 years in 2 pts (9.1%), long distance from the hospital in 3 pts (13.6%) and poor social conditions in 2 pts (9.1%). Distance from DHCU to pts home was &lt; 20 Km in 2 cases ( 9.1%), ≥ 20 &lt; 40 Km in 13 (59.1%) and ≥ 40 Km in 7 (31.8%). As to the phase of disease, 11 pts were in 1st line treatment, and 11 in 2nd or subsequent lines of treatment: among 11 pts treated in 1st line, 5 were transplant eligible and 6 transplant ineligible. On the whole, 212 administrations of sc-dara were performed by DHCU nurses as outpatient: during and/or immediately after home administration, only one pt had adverse events (grade 2 allergic reaction according WHO), leading to dara permanent discontinuation after the 2nd dose at home. Main adverse events during the course of domiciliary treatment were infections (pneumonia in 5 pts, sepsis in 2, cystitis in 1) and deep vein thrombosis in 1 pts. One pt was not yet evaluable for response and one pt discontinued early: among the evaluable 20 pts, 3 achieved a stringent complete remission, 7 a very good partial remission and 2 a partial remission, with an overall response rate of 60%, 6 pts had a stable disease and 2 pts a disease progression. At the last follow-up, 13 pts are alive and 9 pts died (5 from disease progression, 3 from infective complications and 1 from heart disease). Median overall survival from the start of home management was 38.9 months (95%CI 18.5 - 59.2). Conclusions: Nursing treatment at home with sc-dara in frail pts with MM is feasible and safe, making possible a curative approach frontline as well as in advanced phases of disease also in subjects otherwise excluded by best available therapies or forced to long periods of hospitalization. At present, within the Myel-Home project, other monoclonal antibodies (belantamab-mafodotin and talquetamab) are already available for home administration