Targeting CD38 in immune thrombocytopenia: Rationale and a scoping review of daratumumab

Immune thrombocytopenia (ITP) remains therapeutically challenging in patients with refractory or relapsed disease despite expanding second-line options. Increasing evidence implicates autoreactive plasma cells in treatment resistance, providing a rationale for anti-CD38 therapy. In this review, we place anti-CD38 therapy in ITP within its broader biological and emerging clinical context, while formally synthesizing the published daratumumab literature through a scoping review. The available evidence suggests that anti-CD38 therapy, particularly daratumumab, may induce rapid platelet responses and durable remissions in a subset of heavily pretreated patients. However, the current evidence base is heterogeneous and largely uncontrolled, spanning different patient populations, treatment settings, response definitions, and concomitant therapies. Safety reporting is inconsistent, although infusion-related reactions, infections, and hypogammaglobulinemia are recurring concerns. Anti-CD38 therapy represents a promising investigational approach for refractory ITP, with daratumumab currently supported by most robust clinical data; however prospective studies are needed to better define its optimal use, safety profile, and durability of response.