Daratumumab (pronounced dar-ra-to-moo-mab) is a targeted cancer drug. It is a treatment for myeloma. It is also called Darzalex.
You might have daratumumab on its own or with other cancer drugs.
How does daratumumab work?
Daratumumab is a type of targeted cancer drug called a monoclonal antibody (MAB). It works by targeting a certain protein (called CD38) on myeloma cells so your immune system can recognise them. The immune system can then attack and kill the myeloma cells.
How do you have daratumumab?
You usually have daratumumab as an injection under the skin. In some situations you might have it as a drip into a vein (intravenously).
Injection under the skin
You usually have injections under the skin (subcutaneous injection) into the tummy (abdomen)
You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.
Into the bloodstream
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
If you don’t have a central line
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.
How often do you have daratumumab?
You have daratumumab as cycles of treatment. Each cycle is 28 days (4 weeks). When you have daratumumab depends on which cycle you are on.
You have daratumumab for as long as it is working and your side effects aren’t too bad.
When you have daratumumab may be different if you’re having it with other cancer drugs.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
What are the side effects of daratumumab?
Side effects can vary from person to person. They also depend on what other treatments you're having.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
you have severe side effects
your side effects aren’t getting any better
your side effects are getting worse
Early treatment can help manage side effects better.
Contact your advice line immediately if you have signs of infection, including a temperature above 37.5C or below 36C.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.
Common side effects
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of getting an infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
Bruising, bleeding gums or nosebleeds
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
Breathlessness and looking pale
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Reaction to the drug
A reaction to this drug is most likely to happen in the first 48 hours of having it. Your nurse will check you regularly. Symptoms include fever, chills, chest pain, rash, vomiting, facial swelling or difficulty breathing. You have medicines before and after having the drug to try to prevent a reaction.
Numbness or tingling in fingers or toes
Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.
Diarrhoea or constipation
Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.
Tiredness and weakness (fatigue)
You might feel very tired and as though you lack energy.
Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.
Difficulty sleeping (insomnia)
If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help.
Swollen hands and legs
You may have swelling of your hands and legs due to a build up of fluid (oedema).
Less commonly, you might get fluid build up in the lungs (pulmonary oedema).
Cough or shortness of breath
Tell your nurse or call the advice line if you have a cough or feel short of breath. This could be for different reasons, including a sign of infection. They can find the cause and help treat it.
You might have back pain. Speak to your doctor if this is a problem for you. They can prescribe medicine to help.
Let your doctor or nurse know if you have muscle spasms during or after having treatment.
Loss of appetite
You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.
High blood pressure
Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. You have your blood pressure checked regularly.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
- an irregular and often fast heartbeat called atrial fibrillation - you might have a heart trace test (ECG) to check for this
- high level of sugar in the blood
- low levels of calcium in the blood
- low levels of fluid in the body (dehydration)
- inflammation of the pancreas (pancreatitis)
- skin rash or itching
- redness, soreness or swelling at the injection site
Rare side effects
These side effects happen in fewer than 1 in 100 people (less than 1%).
- hepatitis B (a viral infection affecting the liver) can flare up (reactivate) – your doctor will check to see if you’ve had this virus in the past
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
This drug contains sodium. Talk to your team if you are on a low sodium diet.
Pregnancy and contraception
This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for a few months afterwards.
Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.
It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.
Treatment for other conditions
If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.