Hello Darzalex, Please Be My Friend


Wellllllllllll… here we go…
The long awaited treatment change to Darzalex is looming tomorrow, Tuesday, February 28, 2017, first thing in the morning!

My hope is for NO side effect DRAMA on this first infusion.
For those familiar with Darza, you KNOW what I am referring to.
For those unfamiliar with Darza, truth is, many (most) myeloma patients experience some sort of “first infusion” reaction, above and beyond the “normal” reaction one has to (other) new chemos. When switching treatments (which has happened more times than I can count now!), I read read read and consult 24/7 about the new medication, treatment details, possible consequences, etc., so I know what I am getting into. I may not fully understand all Darza’s bio-chemistry, but at least I won’t be surprised if I do have an initial infusion reaction. 
Am I scared? No. Am I nervous? No. Am I anxious? Yes… Anxious to just get this first infusion over and done with. Anxious to know if this treatment will lasso my escalating IgA and M Protein. Anxious to find out if I can be back on the winning side for change. Anxious to be ok for a little bit, if possible. Anxious for a bit of potential “normalcy” in my life, if Darza and I become friends
See Revlimid Dex was challenging regarding GI side effects, but totally worth it prior to SCT (2010), after SCT (2010-2012), then after coming out of remission (2013), until mid 2015. Then Kyprolis Dex gave me at least 9 months, from late 2015 to mid 2016. Then recently Dex, Pomalyst and Velcade, unfortunately barely made a dent. Then actually made a tiny dent, but my Dr and I decided to toss Pom and Velcade aside and go for the new big dog, Darzalex.

So hello to allll day, 8+ hour “slo-mo” infusions Tuesday Feb 28 and Wednesday March 1. The 8+ hour, all day, slow infusion rate is the norm, to help prevent side effects. And if there are side effects, the infusion is stopped, reaction-targeted meds administered, and hopefully, onward I can go. We’ll see what happens!

And what are those intense, serious, potential first infusion side effects? 

DARZALEX® (daratumumab) Important Safety Information – Professional

Infusion Reactions
DARZALEX can cause severe infusion reactions. Approximately half of all
patients experienced a reaction, most during the first infusion.
Infusion reactions can also occur with subsequent infusions. Nearly all
reactions occurred during infusion or within 4 hours of completing an
infusion. Prior to the introduction of post-infusion medication in
clinical trials, infusion reactions occurred up to 48 hours after
infusion. Severe reactions have occurred, including bronchospasm,
hypoxia, dyspnea, and hypertension. Signs and symptoms may include
respiratory symptoms, such as cough, wheezing, larynx and throat
tightness and irritation, laryngeal edema, pulmonary edema, nasal
congestion, and allergic rhinitis. Less common symptoms were
hypotension, headache, rash, urticaria, pruritus, nausea, vomiting, and

Pre-medicate patients with antihistamines, antipyretics
and corticosteroids. Frequently monitor patients during the entire
infusion. Interrupt infusion for reactions of any severity and institute
medical management as needed. Permanently discontinue therapy for
life-threatening (Grade 4) reactions. For patients with Grade 1, 2, or 3
reactions, reduce the infusion rate when re-starting the infusion.

reduce the risk of delayed infusion reactions, administer oral
corticosteroids to all patients the first and second day after all
infusions. Patients with a history of obstructive pulmonary disorders
may require additional post-infusion medications to manage respiratory
complications. Consider prescribing short- and long-acting
bronchodilators and inhaled corticosteroids for patients with
obstructive pulmonary disorders.

Interference with Serological Testing
– Daratumumab binds to CD38 on red blood cells (RBCs) and results in a
positive Indirect Antiglobulin Test (Coombs test). Daratumumab-mediated
positive indirect antiglobulin test may persist for up to 6 months after
the last daratumumab infusion. Daratumumab bound to RBCs masks
detection of antibodies to minor antigens in the patient’s serum. The
determination of a patient’s ABO and Rh blood type are not impacted.
Notify blood transfusion centers of this interference with serological
testing and inform blood banks that a patient has received DARZALEX.
Type and screen patients prior to starting DARZALEX.

Interference with Determination of Complete Response
Daratumumab is a human IgG kappa monoclonal antibody that can be
detected on both, the serum protein electrophoresis (SPE) and
immunofixation (IFE) assays used for the clinical monitoring of
endogenous M-protein. This interference can impact the determination of
complete response and of disease progression in some patients with IgG
kappa myeloma protein.

Adverse Reactions – The most
frequently reported adverse reactions (incidence ≥20%) were: fatigue,
nausea, back pain, pyrexia, cough, and upper respiratory tract

Serious adverse reactions were reported in 51 (33%) of
patients. The most frequent serious adverse reactions were pneumonia
(6%), general physical health deterioration (3%), and pyrexia (3%).

MMRF: Darzalez

IMF: Darzalex

So wish me luck and I do hope for the best, with minimal infusion reactions. Me, being me, and proactive as I am, I plan to Dex up Monday, the day before, with 8mg steroids (2 pills). Then Dex up early Tuesday with 20mg (5 pills), before even arriving for the infusion. I may even take some Benadryl in advance too, maybe some Claritin too. YES, all of this PRE-APPROVED by my Dr and chemo lab Pharmacists! I inquired about this at my last appointment, when we agreed to switch from Pom, Velcade to Darzalex. I know I am a “non-conformist” and a bit “rogue”, but not stupid :)) I only do what is medical protocol. I will post an update as soon as I feel ok, to let you know how I did. Thank you in advance for caring as you do, all these years!

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live well, and make a difference somewhere, somehow, with someone or something
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