Patients with multiple myeloma being treated with daratumumab appeared to be at greater risk for Listeria compared with other patients with cancer and other patients with myeloma, according to a recent study.

Preclinical studies had shown that inactivation of CD28 – the mechanism of action for daratumumab – caused an increased susceptibility to Listeria monocytogenes in CD38 knockout mice.

This nested case-control study looked at risk for L monocytogenes among all patients that received daratumumab amid an outbreak at a commercial eatery in a tertiary cancer center in Toronto, Canada, over a 9-month period in 2018. The cancer center serves 284,500 outpatient visits per year.

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Of the 7 patients identified with listeriosis, more than half had myeloma. All of the identified patients had cancer, 57% had myeloma, and 43% were receiving daratumumab.

“Patients with myeloma receiving daratumumab accounted for fewer than 0.3% of potentially exposed individuals, yet comprised 43% of cases,” the researchers wrote.

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After adjustment for hospital visits, patients with myeloma had a 340-fold increased risk for listeriosis compared with other patients with cancer. Specifically, patients with myeloma receiving daratumumab had a 75-fold increased risk for listeriosis compared with other patients with myeloma.

“We suggest that patients receiving daratumumab be provided with dietary advice to avoid unpasteurized dairy products, undercooked meats, or unwashed vegetables,” the researchers wrote. “Antibiotic prophylaxis should be considered using sulfa-methoxazole/trimethoprim, which has activity against Listeria and is routinely indicated for pneumocystis pneumonia prophylaxis with corticosteroid use.”

Disclosure: Some on the authors reported financial relationships with pharmaceutical manufacturers and research institutions. For a full list of disclosures, please refer to the original study.


Khan S, Vaisman A, Hota SS, et al. Listeria susceptibility in patients with multiple myeloma receiving daratumumab-based therapy [published online November 27, 2019]. JAMA Oncol. doi: 10.1001/jamaoncol.2019.5098