Daratumumab-Associated Choroidal Leakage Managed With Desensitization in Relapsed/Refractory Multiple Myeloma: Case Study
By: Wendy LaGrego
Posted: Monday, August 31, 2026
Ocular adverse events associated with daratumumab are rare and remain poorly characterized, raising questions about how to manage affected patients. In a case report published in eJHaem, Metban Mastanzade, of the Division of Hematology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey, and colleagues described a patient with relapsed/refractory multiple myeloma who developed choroidal leakage during her first daratumumab infusion and was subsequently able to resume treatment using a desensitization protocol.
Case Details and Management
The patient was a 68-year-old woman with multiple myeloma who experienced disease progression after induction therapy with bortezomib, cyclophosphamide, and dexamethasone; consolidation with autologous stem cell transplantation; and lenalidomide maintenance. At relapse, she began treatment with daratumumab, bortezomib, and dexamethasone.
On the second day of her initial daratumumab infusion, the patient developed blurred vision, initially affecting one eye and subsequently becoming bilateral. Best-corrected visual acuity was 1.0 in the right eye and 0.9 in the left. Fundoscopic examination revealed bilateral midperipheral drusen-like lesions, whereas anterior segment findings and intraocular pressures were normal.
Multimodal ophthalmologic imaging revealed mid- to late-phase leakage above the optic disc in the left eye on fluorescein angiography and bilateral choroidal hyperfluorescence consistent with choroidal leakage on indocyanine green angiography. Optical coherence tomography (OCT) showed normal macular cross-sections in both eyes but identified subretinal fluid over the left optic disc. Enhanced-depth imaging OCT also demonstrated dilated vessels in Haller’s layer.
Suspecting an ocular adverse drug reaction, clinicians interrupted daratumumab. Because alternative options were limited, they elected to resume treatment with the agent after the patient’s ocular symptoms had completely resolved, using a previously developed 12-step desensitization protocol for monoclonal antibody–related hypersensitivity reactions. The protocol gradually increased daratumumab exposure across three solutions, culminating in administration of the planned 800-mg dose.
Key Takeaways
Following reintroduction of daratumumab, the patient experienced no recurrent ocular symptoms or other rechallenge-related adverse events. Follow-up ophthalmologic evaluation demonstrated reduced subretinal fluid over the left optic disc; OCT imaging showed interval improvement without new intraretinal or subretinal fluid.
The authors noted that daratumumab-related ocular events may reflect nonallergic inflammatory or vascular processes rather than classic IgE-mediated hypersensitivity. Potential mechanisms include complement activation, cytokine release, or idiosyncratic vascular responses that increase choroidal vascular permeability. They proposed that gradual dose escalation during desensitization could attenuate these responses, although recurrence of ocular adverse events despite successful desensitization has previously been reported.
“As a single case,” the authors acknowledged, “causality cannot be definitively established, and long-term ophthalmologic outcomes remain unknown.”
The investigators concluded: “This case highlights a rare ocular complication associated with daratumumab and suggests that desensitization may enable safe continuation of therapy in selected patients with non–vision-threatening findings.”
DISCLOSURE: For full disclosures of the study authors, visit onlinelibrary.wiley.com.
