(176) Optimization of Daratumumab Based Treatment Plans

Poster Abstract: Background/Rationale:
Daratumumab (Darzalex) is a CD38-directed monoclonal antibody used in the treatment of multiple myeloma and amyloidosis. Daratumumab is usually given weekly for 8 weeks, then every 2 weeks during weeks 9 to 24, followed by every 4 weeks. It is available as an intravenous (IV) infusion or subcutaneous (SQ) injection (daratumumab and hyaluronidase-fihj [Darzalex Faspro]). To lower the risk of infusion-related reactions, acetaminophen, diphenhydramine, and dexamethasone are given as pre-medications before daratumumab.
The recommended wait time between pre-medications and administration of daratumumab is 1-3 hours. An alternative to waiting in clinic between pre-medications and administration of daratumumab is for patients to take their dexamethasone at home prior to coming to clinic for infusion or injection. Changing the patient to daratumumab rapid IV infusion or SQ administration of daratumumab-fihj is another way to reduce the patient time in the infusion center.

Objective: To decrease overall patient waiting time when receiving daratumumab while increasing availability of nursing staff and number of appointments in the infusion center.

Methods:
Patients with active treatment plans including daratumumab, as identified by an electronic medical record review, were evaluated for optimization of their daratumumab. Optimization efforts included changing dexamethasone to be given at home prior to infusion then reducing the wait time of the daratumumab infusion/injection and changing IV daratumumab to SQ. Optimization recommendations were compiled for eligible patients and the ordering physician was contacted to sign off on suggested changes. Patients were excluded if they were receiving other IV chemotherapy or at the provider discretion.
Documentation was placed in the medical record to alert both the nursing and pharmacy staff of any changes to the treatment plan. For patients who began taking their dexamethasone at home, a dexamethasone calendar was be made with the medication instructions and the name of the medication on the day they are supposed to take the medication. The impact of this project was evaluated through tracking of interventions made, chair time, daratumumab administration time, and infusion related reactions.

Results: In Progress

Discussion/

Conclusion: In Progress

References (must also be included in final poster): Daratumumab (DARZALEX®) [Package Insert]. DailyMed; Bethesda, MD; November 2023.

Barr H, Dempsey J, Waller A, Huang Y, Williams N, Sharma N, Benson DM, Rosko AE, Efebera YA, Hofmeister CC. Ninety-Minute Daratumumab Infusion is Safe in Multiple Myeloma. Leukemia. 2018 November 9 [cited 2023 November 28]; 32 (11): 2495-2518. DOI: 10.1038/s41375-018-0120-2.

Daratumumab and hyaluronidase-fihj (DARZALEX FASPRO®) [Package Insert]. DailyMed; Bethesda, MD; November 2023.