Daratumumab as first line therapy in primary effusion lymphoma: a case report

Primary effusion lymphoma (PEL) is a rare and aggressive form of non-Hodgkin lymphoma (NHL) accounting for <1% of all cases of lymphoma in the general population. It manifests as malignant effusions within the body affecting the pleural, pericardial and peritoneal cavities. It is seen most commonly in individuals coinfected with the human immunodeficiency virus (HIV) and human herpesvirus-8 (HHV8) and carries a poor prognosis with a median overall survival of approximately 6 months. Treatment options are challenging both from limited evidence in this area, as well as by patient suitability for therapy, as PEL often affects an elderly male population. For those patients with PEL fit for chemotherapy they often will receive a combination regimen, involving an anthracycline, which may not be suitable for some of the elderly population affected, especially those with a history of cardiac disease. In this report, we explored a completely novel approach and describe the only reported case of prolonged clinical remission through the use of daratumumab (an anti-CD38 antibody) as first line of therapy in an 85-year-old gentleman diagnosed with HIV-negative PEL with pericardial involvement. At the time of this report our patient has been in an ongoing clinical remission for over a year and continues on monthly daratumumab maintenance with a good quality of life and no adverse events from therapy.