Some children with acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LL) relapse after treatment. Standard chemotherapy then often is no longer effective. A stem cell transplant may still offer a chance of a cure, but to do so, the disease must first be reduced.
Researchers from several countries - including the Princess Máxima Center - have conducted a study to see if the drug daratumumab can contribute to this.
What is daratumumab?
Daratumumab is a form of immunotherapy. It is a protein that binds to a specific protein (CD38) on the outside of leukemia cells. Thus, daratumumab helps the immune system recognize and attack these diseased cells.
In adults with another form of blood cancer (multiple myeloma), daratumumab is already being used. In this study, children received daratumumab along with chemotherapy.
What are the results?
Between 2018 and 2022, 24 children with recurrent T-cell ALL received daratumumab in combination with chemotherapy.
- 10 of these children (about 42%) showed no signs of the disease anymore after just one course of treatment.
- Overall, 20 of the 24 children responded well to the treatment.
- 18 of the 24 children were subsequently able to receive a stem cell transplant.
Also in children with relapsed LL, daratumumab helped to reduce the disease and enable a transplant.
In children with relapsed B-cell ALL, daratumumab had less effect. None of them had a complete response after the first course.
Side effects were similar to those seen previously in adults.
What does this mean?
This study shows that daratumumab can be safely added to chemotherapy in children with relapsed T-cell ALL or LL. It helps push the disease back so that a stem cell transplant becomes possible. But whether it works better than chemotherapy alone is not yet entirely certain.
For now, this study does not change the standard treatment. Follow-up research is needed for that. The researchers believe that daratumumab may also play a role in children with T-cell ALL who are being treated for the first time.
A similar drug, isatuximab, has also been studied. Its results are expected soon.
More information
The Princess Máxima Center participated in this study.
Would you like to read the scientific publication? Please look here:
Bhatla T, Hogan L MD, Teachey DT, et al. Daratumumab in Pediatric Relapsed/Refractory Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma: DELPHINUS Study. Blood. 2024 Aug 16:blood.2024024493.