1
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Habicht CP, Ridders M, Grueger D, Adolph S, Immenschuh S, Schneeweiss C. Mitigation of therapeutic anti-CD38 antibody interference with fab fragments: How well does it perform? Transfusion 2023; 63:808-816. [PMID: 36707937 DOI: 10.1111/trf.17253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/08/2022] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Administration of anti-CD38 antibodies is a state-of-the-art therapy for patients diagnosed with multiple myeloma (MM). However, this treatment frequently leads to pan-agglutination of red blood cells (RBCs) in patients' serological testing making accurate blood typing and timely transfusion of compatible blood a challenging effort. The antigen masking indirect antiglobulin test (AMIAT) is an approach to address this diagnostic challenge. STUDY DESIGN AND METHODS A new reagent, called DaraEx plus, uses anti-CD38 Fab fragments to mitigate the anti-CD38 antibody interference in serological assays by masking CD38 on the cell surface. Its performance is extensively examined with commercial sera as well as with patient samples, and compared to the current standard method using dithiothreitol (DTT), which denatures the CD38 antigens on test panel erythrocytes. RESULTS In the Bio-Rad ID System, DaraEx plus effectively mitigated the interference caused by anti-CD38 antibodies in 86% of patient samples tested while DTT was successful in only 68%. Moreover, there was no negative influence on DTT-sensitive blood group systems such as KEL upon DaraEx plus treatment. The agglutination reactions of all tested anti-CD38 antibodies (Daratumumab, Felzartamab, and Isatuximab) were inhibited by DaraEx plus. The treatment was successful only if DaraEx plus was added to the test cells before the sample. Some of the other gel card systems tested showed background reactions with DaraEx plus-treated cells. CONCLUSION DaraEx plus treatment is straightforward and quick to perform. In the Bio-Rad ID System, it is superior to DTT treatment in the prevention of anti-CD38 antibody interference.
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Affiliation(s)
| | | | - Daniela Grueger
- Imusyn GmbH & Co. KG, Hanover, Germany.,Hannover Medical School, Institute of Transfusion Medicine and Transplant Engineering, Hanover, Germany
| | | | - Stephan Immenschuh
- Hannover Medical School, Institute of Transfusion Medicine and Transplant Engineering, Hanover, Germany
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2
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Du C, Sui W, Huang H, Zhang Y, Ding X, Gao C, Wang Y. Effect of clinical application of anti-CD38 and anti-CD47 monoclonal antibodies on blood group detection and transfusion therapy and treatment. Leuk Res 2022; 122:106953. [PMID: 36182722 DOI: 10.1016/j.leukres.2022.106953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND To investigate the effect of anti-CD38 monoclonal antibodies (mAb) (daratumumab, DARA) and anti-CD47 mAb combined with azacytidine on blood transfusion compatibility tests, transfusion effects in the treatment of multiple myeloma or acute myeloid leukemia and the corresponding management strategy. MATERIALS AND METHODS Among the 19 patients who were treated with DARA and anti-CD47 mAb, 4 patients with cross matching incompatibility were selected. The ABO blood group, the Rh blood group, irregular antibody screening and direct antiglobulin test (DAT) and cross matching testing were performed before and after the application of mAbs using serological methods. Then, irregular antibody screening and microcolumn gel cross matching tests were performed with donor and recipient erythrocytes and serum treated with DL-dithiothreitol (DTT) and Immucor kit, respectively. The transfusion effect was monitored. RESULTS 21.05% (4/19) patients had mismatched cross-matching results after mAb treatment. The agglutination intensity of irregular antibody screening tests (3 + ∼ 4 +) after anti-CD47 mAb was higher than that (1 + ∼ 2 +) after DARA. In the DARA group, treating RBCs with 0.2 mol L-1 DTT eliminated the DARA interference with antibody screening. In the anti-CD47 mAb group, the antibody screening, cross-matching test and DAT had been strongly interfered, and using Immucor kit eliminated the interference with antibody screening testing. There was no difference in the transfusion effect. CONCLUSION The application of mAb drugs led to incompatibility of cross matching tests, and the transfusion effect was not affected.
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Affiliation(s)
- Chunhong Du
- Department of Blood Transfusion, Tianjin Medical University General Hospital, Tianjin, China
| | - Weijia Sui
- Department of Blood Transfusion, Tianjin Medical University General Hospital, Tianjin, China
| | - Haitao Huang
- Department of Blood Transfusion, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Zhang
- Department of Blood Transfusion, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Ding
- Department of Blood Transfusion, Tianjin Medical University General Hospital, Tianjin, China
| | - Cuicui Gao
- Department of Blood Transfusion, Tianjin Medical University General Hospital, Tianjin, China
| | - Yihao Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China.
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3
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Aung F, Spencer J, Potter D, Pham TD, Farooqui N, Platt KR, Zayat R, Oliveira M, Smeland-Wagman R, Petersen E, Kaufman RM. Efficient neutralization of daratumumab in pretransfusion samples using a novel recombinant monoclonal anti-idiotype antibody. Transfusion 2022; 62:1511-1518. [PMID: 35866570 DOI: 10.1111/trf.17006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anti-CD38 antibodies such as daratumumab (DARA) are critical therapies for multiple myeloma and other diseases. Unfortunately, anti-CD38 antibodies cause panreactivity in indirect antiglobulin tests (IATs), complicating blood compatibility testing. The anti-CD38 interference is most often mitigated by treating reagent red blood cells (RBCs) with dithiothreitol (DTT). However, when using the DTT method, not all RBC antibody specificities can be detected (e.g., anti-K), and the DTT method is impractical for some transfusion services. We evaluated the ability of a new anti-idiotype antibody to neutralize DARA in vitro and eliminate the anti-CD38 interference. STUDY DESIGN AND METHODS A recombinant monoclonal rabbit anti-DARA idiotype antibody ("anti-DARA") was generated. The ratio of anti-DARA required to neutralize DARA in spiked samples was evaluated in IATs performed in gel. IATs performed in tube were used to demonstrate that anti-DARA allows alloantibody detection in the presence of DARA. Plasma samples from 29 patients receiving DARA were treated with a fixed quantity of anti-DARA (120 μg) before performing antibody detection tests (screens) in tube. RESULTS Anti-DARA used at or above a 1:1 ratio with DARA eliminated the DARA interference with IATs. Anti-DARA allowed detection of both alloanti-E and alloanti-K in the presence of DARA. In 27/29 (93.1%) clinical samples, 120 μg anti-DARA was sufficient to neutralize the DARA in 100 μl patient plasma. DISCUSSION An anti-DARA:DARA ratio as low as 1:1 is sufficient to neutralize DARA in solution. A fixed amount of anti-DARA eliminates the anti-CD38 interference in most patient samples.
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Affiliation(s)
- Fleur Aung
- Department of Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Thuy-Dung Pham
- Department of Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Naheed Farooqui
- Department of Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Kathryn R Platt
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raja Zayat
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Melanie Oliveira
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Robin Smeland-Wagman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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4
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Grüger D, Immenschuh S, Hervatin R, Schneeweiß C. Immunhämatologische Daratumumab-Interferenz im Verlauf einer Myelomtherapie. Transfusionsmedizin 2021. [DOI: 10.1055/a-1521-8045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungAnti-CD38-Antikörper werden vermehrt in der Klinik zur Behandlung von multiplen Myelomen und weiteren Indikationen eingesetzt. CD38 ist ein Oberflächenmolekül, das auf einer Reihe von Zellen und Geweben exprimiert wird, auch auf Erythrozyten. Nach Verabreichung von Anti-CD38-Antikörpern wie Daratumumab kommt es regelmäßig zur Interferenz im indirekten Antihumanglobulintest (IAT), was die Bestimmung irregulärer Antikörper behindert sowie auch die Zuverlässigkeit von Serumverträglichkeitsproben stark einschränkt. Mehrere Verfahren zum Umgang dieser Interferenz werden derzeit von der Deutschen Gesellschaft für Transfusionsmedizin und Immunhämatologie (DGTI) empfohlen. Wir stellen hier einen Vergleich zwischen der DTT-Methode und der Maskierung von CD38 durch ein neues Reagens an einem Patienten mit asekretorischem multiplen Myelom vor.
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Affiliation(s)
- Daniela Grüger
- Imusyn GmbH & Co. KG, Hannover, Deutschland
- Institut für Transfusionsmedizin und Transplant Engineering, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stephan Immenschuh
- Institut für Transfusionsmedizin und Transplant Engineering, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Rafaela Hervatin
- Institut für Transfusionsmedizin und Transplant Engineering, Medizinische Hochschule Hannover, Hannover, Deutschland
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Zhou Y, Chen L, Jiang T, Fan L, Lei H, Wang Y, Heililahong H, Mi J, Du D, Miao T, Xia R, Wang X, Xiang D, Cai X, Tang X. 2-Mercaptoethanol (2-ME)-based IATs or Polybrene method mitigates the interference of daratumumab on blood compatibility tests. Hematology 2021; 26:365-370. [PMID: 33971806 DOI: 10.1080/16078454.2021.1918916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Treating red blood cells (RBCs) with dithiothreitol (DTT) is a wildly-recommended to overcome the interference of the daratumumab (DARA) with blood compatibility testing. Nevertheless, DTT can be hard to obtain in the clinical laboratory, while its use in routine practice may be time-consuming. In the following study, we explored the feasibility of using a commercial 2-mercaptoethanol (2-ME) working solution or the time-saving Polybrene method to mitigate DARA interference. METHODS Antibody screening and cross-matching were performed using 2-ME or DTT-based indirect antiglobulin tests (IATs) and Polybrene method (with human IgG anti-E same IATs titer as DARA as positive control) on 37 samples. Most clinically important blood group antigens on RBCs were detected after treatment with 2-ME or DTT. RESULTS Treating RBCs with 2-ME eliminates the DARA interference with the antibody screening or cross-matching; yet, K antigen is denatured during treatment. DARA does not interfere with antibody screening and cross-matching via Polybrene method, while 2+ agglutinations of anti-E antibody with the same titer (IATs method) as DARA could be observed in the positive controls via this method. CONCLUSION 2-ME-based IATs or Polybrene method could replace DTT-based IATs to mitigate DARA interference.
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Affiliation(s)
- Ye Zhou
- Department of Blood Transfusion, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Leiyu Chen
- Department of Blood Transfusion, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Tianshu Jiang
- Department of Blood Transfusion, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Liangfeng Fan
- Blood Group Reference Laboratory, Shanghai Blood Center, Shanghai, People's Republic of China
| | - Hang Lei
- Department of Blood Transfusion, Laboratory Diagnosis Center, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Yuqing Wang
- Department of Blood Transfusion, Laboratory Diagnosis Center, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Hasiyati Heililahong
- Department of Blood Transfusion, Laboratory Diagnosis Center, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Jianqing Mi
- Department of Hematology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Danxin Du
- Department of Blood Transfusion, Huashan Hospital Fudan University, Shanghai, People's Republic of China
| | - Tianhong Miao
- Blood Group Reference Laboratory, Beijing Red Cross Blood Center, Beijing, People's Republic of China
| | - Rong Xia
- Department of Blood Transfusion, Huashan Hospital Fudan University, Shanghai, People's Republic of China
| | - Xuefeng Wang
- Department of Blood Transfusion, Laboratory Diagnosis Center, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Dong Xiang
- Blood Group Reference Laboratory, Shanghai Blood Center, Shanghai, People's Republic of China
| | - Xiaohong Cai
- Department of Blood Transfusion, Laboratory Diagnosis Center, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Xiaofeng Tang
- Department of Blood Transfusion, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
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6
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Nedumcheril MT, DeSimone RA, Racine-Brzostek SE, Chaekal OK, Vasovic LV. Overcoming Drug Interference in Transfusion Testing: A Spotlight on Daratumumab. J Blood Med 2021; 12:327-336. [PMID: 34079412 PMCID: PMC8164699 DOI: 10.2147/jbm.s213510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/29/2021] [Indexed: 12/01/2022] Open
Abstract
Daratumumab, a monoclonal antibody therapeutic, is highly efficacious and widely used in all stages of multiple myeloma and amyloidosis and has promising activity in other hematologic disorders. Daratumumab interacts with red blood cells, interfering with pre-transfusion testing. This interference can lead to compromising transfusion safety, extensive blood bank work ups and delays in provision of compatible units. Several methods have been developed to negate daratumumab interference with indirect antiglobulin testing. They are based on i) standard blood bank techniques including dithiothreitol and enzymatic treatment of reagent cells, using reagent red blood cells negative for CD38, ii) blocking CD38 antigens on reagent or donor cells, iii) neutralization of anti-CD38 antibody in patient plasma prior to testing, and iv) extended antigen typing of patient red blood cells in conjunction with provision of phenotypically matched units for transfusion. Implementation of those methods by the blood bank should be a planned effort coordinated with the patient’s clinical team. Timely involvement of blood bank and transfusion services and educational efforts by both blood banks and clinical providers can improve the overall daratumumab safety profile in regard to blood transfusion.
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Affiliation(s)
- Marilyn T Nedumcheril
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.,New York Blood Center Enterprises, New York, NY, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Sabrina E Racine-Brzostek
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Ok Kyong Chaekal
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.,Department of Medicine/Division of Hematology-Oncology New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
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7
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Koenigbauer UF. Laboratory Detection of Blood Groups and Provision of Red Cells. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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8
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Jones AD, Moayeri M, Nambiar A. Impact of new myeloma agents on the transfusion laboratory. Pathology 2021; 53:427-437. [PMID: 33707006 DOI: 10.1016/j.pathol.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 12/11/2022]
Abstract
Monoclonal antibody (mAb) therapy targeting CD38 and CD47 antigens expressed on cancer cells has transformed therapy options for patients with multiple myeloma as well as other haematological and non-haematological malignancies. While the on target effects of these new drugs highlight the promise of precision cancer therapeutics, the unintended, off target binding of drugs to red blood cells (RBCs) and platelets has required transfusion service laboratories (TSL) and immunohaematology reference laboratories (IRL) to innovate and rapidly set up processes and testing protocols to overcome the significant interference in routine pre-transfusion tests caused by these agents. Binding of anti-CD38 and anti-CD47 drugs to reagent RBCs leads to false positive pan-agglutination during the antihuman globulin phase of testing, making it difficult to rule out underlying alloantibodies, and leading to delays in setting up compatible units for RBC transfusion. Anti-CD47 agents can also interfere with ABO/Rh typing studies. Several methods to successfully mitigate interference have been described, such as treatment of reagent RBCs with reducing agents or enzymes, allogeneic RBC adsorption studies and drug specific neutralisation assays; all methods have limitations. TSLs should select an approach that best fits their workflow and expertise and takes into consideration their level of access to specialised outside testing, local blood supplier capabilities, and the type of patient population served. For platelet refractory patients, samples should be tested by platelet antibody assays that are known to be unaffected by drug therapy. RBC transfusion support for multiple myeloma patients receiving anti-CD38 or anti-CD47 drugs can be optimised by establishing good communication between the clinical teams and TSLs, building electronic notification processes, and ensuring timely completion of baseline pre-transfusion testing and RBC phenotype/genotype prior to starting therapy. Staff education, standardisation of laboratory mitigation measures, and implementation of testing algorithms that consider mAb-induced interference when working up a pan-agglutinin help to significantly decrease delays that would otherwise result if standard methods were employed to complete antibody identification studies.
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Affiliation(s)
- Andrew D Jones
- UCSF Medical Center, Department of Laboratory Medicine, San Francisco, CA, USA.
| | - Morvarid Moayeri
- UCSF Medical Center, Department of Laboratory Medicine, San Francisco, CA, USA
| | - Ashok Nambiar
- UCSF Medical Center, Department of Laboratory Medicine, San Francisco, CA, USA
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9
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Jain A, Ramasamy K. Evolving Role of Daratumumab: From Backbencher to Frontline Agent. Clinical Lymphoma Myeloma and Leukemia 2020; 20:572-87. [DOI: 10.1016/j.clml.2020.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/08/2020] [Accepted: 03/19/2020] [Indexed: 12/11/2022]
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10
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Kim TY, Yoon MS, Hustinx H, Sim J, Wan HI, Kim H. Assessing and mitigating the interference ofALX148, a novelCD47blocking agent, in pretransfusion compatibility testing. Transfusion 2020; 60:2399-2407. [DOI: 10.1111/trf.16009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/13/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Tae Yeul Kim
- Department of Laboratory Medicine and Genetics Samsung Medical Center Seoul South Korea
| | - Mi Sook Yoon
- Department of Laboratory Medicine Seoul National University Hospital Seoul South Korea
| | - Hein Hustinx
- Interregional Blood Transfusion SRC Ltd. Berne Switzerland
| | | | | | - Hyungsuk Kim
- Department of Laboratory Medicine Seoul National University Hospital Seoul South Korea
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11
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Baig NA, Dukek BA, Falbo DK, Wakefield LL, DiGuardo MA, Bobr A, Kreuter JD, Gandhi MJ. Daratumumab interference in flow cytometric anti-granulocyte antibody testing can be overcome using non-human blocking antibodies. Vox Sang 2020; 116:116-122. [PMID: 32797679 DOI: 10.1111/vox.12989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/20/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Daratumumab (DARA), a human IgG1K monoclonal antibody targeting CD38, is used to treat refractory multiple myeloma patients. CD38 is expressed on many cell types (RBCs, granulocytes, lymphocytes, etc.), and thus, DARA can interfere with serological tests. Information regarding how DARA affects anti-granulocyte antibody (AGA) testing and optimal neutralization of DARA will help laboratories perform accurate testing. METHODS Screening of AGA was performed by the granulocyte agglutination test (GAT) and the flow cytometric granulocyte immunofluorescence test (Flow-GIFT). Samples were tested from patients on DARA (n = 7), non-transfused blood donors (healthy controls, n = 7) and AGA reactive samples (positive controls, n = 5). Two neutralization experiments, CD38 removal with DTT and DARA epitope blockage with mouse anti-CD38, were evaluated. RESULTS Positive reactivity of human IgG binding was observed in 5/7 DARA cases when tested by Flow-GIFT; however, all 7 cases had negative GAT agglutination results. Further studies by Flow-GIFT revealed DARA concentrations >0·63 μg/ml bound to granulocytes. DARA binding was negated by DTT though a reduced Flow-GIFT sensitivity was observed in positive control samples due to increased background detection of human IgG. Mouse anti-CD38 neutralized the detection of human IgG observed in DARA-treated patient serum without effecting controls. CONCLUSION We established that DARA can interfere with AGA testing, leading to false positive Flow-GIFT results without causing GAT agglutination. DTT treatment increased background binding of secondary antibodies causing a decrease in Flow-GIFT sensitivity. In comparison, blockage of the DARA binding epitope using mouse anti-CD38 antibody was effective in neutralizing DARA interference while maintaining Flow-GIFT sensitivity.
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Affiliation(s)
- Nisar A Baig
- Tissue Typing Lab, Transfusion Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian A Dukek
- Tissue Typing Lab, Transfusion Medicine, Mayo Clinic, Rochester, MN, USA
| | - Deborah K Falbo
- Tissue Typing Lab, Transfusion Medicine, Mayo Clinic, Rochester, MN, USA
| | - Laurie L Wakefield
- Tissue Typing Lab, Transfusion Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Aleh Bobr
- Tissue Typing Lab, Transfusion Medicine, Mayo Clinic, Rochester, MN, USA.,Transfusion Lab, University of Nebraska Medical Center, Omaha, NE, USA
| | - Justin D Kreuter
- Tissue Typing Lab, Transfusion Medicine, Mayo Clinic, Rochester, MN, USA
| | - Manish J Gandhi
- Tissue Typing Lab, Transfusion Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Tremblay T, Branch DR, Loubaki L. Daudi cell stroma: An alternative to dithiothreitol to resolve daratumumab interference in pretransfusion testing. Transfusion 2020; 60:2090-2096. [PMID: 32632934 DOI: 10.1111/trf.15932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022]
Abstract
Treatment of red blood cells with dithiothreitol (DTT) or trypsin effectively denatures CD38; however, this treatment damages other antigens, some of which are of clinical importance. Thus, other avenues to deplete daratumumab (DARA) from plasma samples should be explored. STUDY DESIGN AND METHODS The Daudi B-cell line was found to express high levels of CD38 and was sonicated in a sonication buffer to achieve complete cell lysis. The resulting stroma preparation was centrifuged at 20 000g for 20 minutes and then mixed with 250 μL of DARA-plasma and incubated for 10 minutes at 37°C. The stroma-DARA-plasma mixture was centrifuged again, and the supernatant was collected and subjected to four additional rounds of adsorption with fresh stroma. DARA-depleted plasma was tested by gel indirect antiglobulin test (IAT). RESULTS CD38 expression on Daudi cells was confirmed by flow cytometry. Gel IAT analysis showed that the incubation of plasma from DARA-treated patients with Daudi cells stroma resulted in a significant depletion of DARA but allowing detection of other alloantibodies of interest such as anti-K, anti-Yta , and anti-Gya . CONCLUSIONS Daudi cell stroma is inexpensive, easy to prepare in large batches, and can be used as an off-the-shelf reagent. Incubation of plasma from DARA-treated patients with Daudi cell stroma can efficiently overcome DARA interference in serologic testing without affecting DTT- or trypsin-sensitive antigens.
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Affiliation(s)
- Tony Tremblay
- Medical Affairs and Innovation, Héma-Québec, Québec, Quebec, Canada
| | - Donald R Branch
- Center for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
| | - Lionel Loubaki
- Medical Affairs and Innovation, Héma-Québec, Québec, Quebec, Canada.,Department of Biochemistry, Microbiology and Bioinformatics, Laval University, Québec, Quebec, Canada
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13
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Izaguirre EC, Del Mar Luis-Hidalgo M, González LL, Castaño CA. New method for overcoming the interference produced by anti-CD38 monoclonal antibodies in compatibility testing. Blood Transfus 2020; 18:290-4. [PMID: 32530397 DOI: 10.2450/2020.0004-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/23/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Plasma of patients taking anti-CD38 monoclonal antibodies (MoAbs) leads to panagglutination in the indirect antiglobulin test (IAT), that can mask clinically significant alloantibodies. Dithiothreitol (DTT) treatment of test RBCs is the more widespread method for avoiding this interference. Current DTT 0.2 mol/L method is time consuming and damages several red blood groups antigens. This study aims to evaluate low concentration DTT treatment of RBCs adapted for gel testing. MATERIALS AND METHODS Four DTT concentrations (0.01, 0.02, 0.03, and 0.04 mol/L), and three gel test brands were evaluated on six DARA patient's samples. Briefly, the method consists of pipetting 50 μL of 0.8% RBCs on AHG micro columns, followed by 25 μL of DTT, thoroughly mixing and 15 min incubation at 37 °C. Then, 25 μL of serum/plasma is added to proceed to IAT. In order to asses the effect of DTT 0.04 mol/L on different blood group antigens, serial dilutions of sera containing anti-K, -k, -Kpb, -Lub, -Yta and anti-JMH antibodies were tested against DTT-RBCs. One sample of a DARA patient with known alloantibodies as well as samples of two patients inoculated with anti-K and anti-Fya were evaluated. RESULTS RBCs treatment with DTT 0.04 mol/L for 15 min completely eliminated anti CD38 panagglutination in all samples studied and worked with different reactivity intensities in IAT and gel brands. The new method allowed the detection of underlying anti-D, anti-E, anti-K and anti-Fya alloantibodies. Titration assays demonstrated no denaturation of Kell, Lutheran, Cartwright and JMH antigens. DISCUSSION The new DTT method adapted for gel testing is efficacious, simple and only adds 15 min over regular IAT. Pheno/genotyping before DARA treatment or transfusion of K negative RBCs may be unnecessary.
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Ye Z, Wolf LA, Mettman D, Plapp FV. Risk of RBC alloimmunization in multiple myeloma patients treated by Daratumumab. Vox Sang 2019; 115:207-212. [PMID: 31729042 DOI: 10.1111/vox.12864] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Daratumumab (DARA) is a human monoclonal antibody for the treatment of multiple myeloma (MM). DARA binds to CD38 on RBCs and interferes with detection of RBC alloantibodies. The objective of this study was to evaluate the risk of RBC alloimmunization in MM patients treated with DARA. MATERIALS AND METHODS A retrospective study of the complete serological profile and transfusion history of 45 MM patients received transfusion and treated with DARA from July 2015 to December 2018 was undertaken. All cases with positive Ab screens were treated with DTT to identify RBC alloantibodies. RBC transfusion history was monitored between the first DARA dose to the last or extending to the first negative Ab screen after the last DARA dose if the Ab screen was ever positive. Forty-six MM patients received transfusion but not DARA were studied as control group. RESULTS Totally 184 Ab screens were done on 45 patients transfused with ABO-Rh compatible RBCs, phenotypically matched units or both. None of them showed detectable alloantibodies after DTT treatment. The duration of Ab screening positivity varied markedly, ranging from 25 days to 5 months after the last dose. Two of 46 patients in the control group had preexisting alloantibodies but no new alloantibodies were detected during study period. CONCLUSIONS Our results indicate that the risk of forming new RBC alloantibodies after transfusion in MM patients treated with current regimens is very low and no DARA-associated difference in the alloimmunization risk. No significant difference in alloimmunization is detected between ABO-Rh compatible and phenotypically matched transfusion.
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Affiliation(s)
- Zhan Ye
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Laurie A Wolf
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Daniel Mettman
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Fred V Plapp
- University of Kansas Medical Center, Kansas City, Kansas, USA
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Brierley CK, Staves J, Roberts C, Johnson H, Vyas P, Goodnough LT, Murphy MF. The effects of monoclonal anti-CD47 on RBCs, compatibility testing, and transfusion requirements in refractory acute myeloid leukemia. Transfusion 2019; 59:2248-2254. [PMID: 31183877 DOI: 10.1111/trf.15397] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND CD47 is a novel therapeutic target in the treatment of solid-organ and hematologic malignancies. CD47 is also expressed on RBCs. Here, we report our experience of the RBC effects and the impact on blood bank testing and transfusion management in a Phase 1 trial of the humanized anti-CD47 monoclonal antibody Hu5F9-G4 in relapsed or primary refractory acute myeloid leukemia (AML) (NCT02678338). STUDY DESIGN AND METHODS Nineteen patients with relapsed or primary refractory AML treated across five UK centers were included for analysis. Patients received escalating doses of Hu5F9-G4. Serial laboratory data were collected to evaluate impact on hemoglobin (Hb), markers of hemolysis (bilirubin, lactate dehydrogenase, reticulocyte count), transfusion requirements, and blood compatibility testing. RESULTS A decline in Hb was observed with drug administration (median Hb change, -1.0 g/dL; range, 0.4-1.6) with associated increase in transfusion requirements. Patients responded to transfusion with a median Hb increment per unit of 1.0 g/dL. RBC agglutination was seen in all cases without associated change in Hb, lactate dehydrogenase, bilirubin, or reticulocyte count. Nine of 19 (47%) patients developed a newly positive antibody screen with a pan-agglutinin identified in plasma. Invalid ABO blood grouping occurred in 4 of 12 (33%) non-group O patients due to anomalous reactivity in the reverse ABO-type results. CONCLUSIONS Treatment with Hu5F9-G4 in patients with AML resulted in an Hb decline and increased transfusion requirements. Problems with ABO blood typing and compatibility testing were widely observed and should be expected by centers treating recipients of Hu5F9-G4.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anemia/chemically induced
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacology
- Blood Grouping and Crossmatching
- Blood Transfusion
- CD47 Antigen/antagonists & inhibitors
- Diagnostic Errors/prevention & control
- Erythrocytes/drug effects
- Humans
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/therapy
- Middle Aged
- Neoplasm Recurrence, Local/therapy
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Affiliation(s)
- C K Brierley
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- MRC Molecular Haematology Unit, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - J Staves
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - C Roberts
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - H Johnson
- Oncology Clinical Trials Office (OCTO), Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - P Vyas
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- MRC Molecular Haematology Unit, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - L T Goodnough
- Departments of Pathology and Medicine, Stanford University, Stanford, California
| | - M F Murphy
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- National Health Service Blood and Transplant, Oxford, United Kingdom
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16
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Nooka AK, Kaufman JL, Hofmeister CC, Joseph NS, Heffner TL, Gupta VA, Sullivan HC, Neish AS, Dhodapkar MV, Lonial S. Daratumumab in multiple myeloma. Cancer 2019; 125:2364-2382. [PMID: 30951198 DOI: 10.1002/cncr.32065] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/11/2018] [Accepted: 01/03/2019] [Indexed: 12/18/2022]
Abstract
The development of effective monoclonal antibodies for the treatment of myeloma has been a long journey of clinical and drug development. Identification of the right target antigen was a critical part of the process. CD38 as a target has been considered for some time, but clinically, daratumumab, a CD38 monoclonal antibody, was the first to be tested, and it has delivered the best clinical responses as a single agent to date. Its proven safety and efficacy in combination with other antimyeloma agents have led to several US Food and Drug Administration approvals for treating myeloma. Furthermore, the results of early trials in the induction therapy setting have demonstrated a beneficial role when it is added to the existing induction regimens. This review summarizes the importance of CD38 as a target and examines the clinical development of the CD38 monoclonal antibody daratumumab and its clinical significance in combination regimens in both patients with relapsed/refractory myeloma and patients with newly diagnosed myeloma.
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Affiliation(s)
- Ajay K Nooka
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jonathan L Kaufman
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Craig C Hofmeister
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nisha S Joseph
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Thomas L Heffner
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Vikas A Gupta
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Andrew S Neish
- Department of Pathology, Emory University, Atlanta, Georgia
| | - Madhav V Dhodapkar
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Cushing MM, DeSimone RA, Goel R, Hsu YMS, Parra P, Racine-Brzostek SE, Degtyaryova D, Lo DT, Morrison M, Crowley KM, Rossi A, Vasovic LV. The impact of Daratumumab on transfusion service costs. Transfusion 2019; 59:1252-1258. [PMID: 30620407 DOI: 10.1111/trf.15134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Daratumumab (DARA) is a human IgG1κ monoclonal antibody directed against CD38, approved for the treatment of multiple myeloma. As CD38 is expressed on RBCs, DARA can interfere with pretransfusion testing. DARA interference can be negated by denaturation of CD38 on RBCs with dithiothreitol (DTT) reagents. Because of this interference in pretransfusion testing, our hospital implemented a notification and testing/transfusion algorithm (NATTA) for pretransfusion testing and RBC product provision for DARA patients. This standardized approach combines DTT-based testing with selective genotyping and the provision of phenotypically similar RBCs for patients with clinically significant antibodies. STUDY DESIGN AND METHODS We evaluated pretransfusion test results and transfusion requirements for 91 DARA patients in an academic medical center over 1 year to determine the incremental cost of pretransfusion testing and RBC selection. The actual costs for the NATTA approach were compared to a theoretical approach using universal genotyping with a provision of phenotypically similar RBC transfusions. RESULTS The annual cost of testing related to DARA after NATTA implementation was $535.76 per patient. The simulated annual cost for the alternative genotyping with provision of phenotypically similar RBC transfusions approach was $934.83 per patient. CONCLUSION In our entire cohort of DARA patients, a DTT-based testing algorithm with selective genotyping and provision of phenotypically similar RBCs only for patients with clinically significant antibodies was less expensive than a simulated model of universal genotyping and provision of phenotypically similar RBCs.
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Affiliation(s)
- Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Ruchika Goel
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Yen-Michael S Hsu
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Priscilla Parra
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Sabrina E Racine-Brzostek
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Diana Degtyaryova
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Dian T Lo
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Meta Morrison
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Kathleen M Crowley
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Adrianna Rossi
- Department of Medicine/Division of Hematology-Oncology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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18
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Lancman G, Arinsburg S, Jhang J, Cho HJ, Jagannath S, Madduri D, Parekh S, Richter J, Chari A. Blood Transfusion Management for Patients Treated With Anti-CD38 Monoclonal Antibodies. Front Immunol 2018; 9:2616. [PMID: 30498492 PMCID: PMC6249335 DOI: 10.3389/fimmu.2018.02616] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/24/2018] [Indexed: 12/31/2022] Open
Abstract
Daratumumab has proven to be highly efficacious for relapsed and refractory multiple myeloma (MM) and has recently been approved in the frontline setting for MM patients ineligible for transplantation. In the future, expanded indications are possible for daratumumab and other anti-CD38 monoclonal antibodies in development. For several years, it has been recognized that these therapies interfere with blood bank testing by binding to CD38 on red blood cells and causing panagglutination on the Indirect Antiglobulin Test. This can lead to redundant testing and significant delays in patient care. Given the anticipated increase in utilization of anti-CD38 monoclonal antibodies, as well as the transfusion needs of MM patients, it is critical to understand the nature of this interference with blood bank testing and to optimize clinical and laboratory procedures. In this review, we summarize the pathophysiology of this phenomenon, examine the clinical data reported to date, describe currently available methods to resolve this issue, and lastly provide a guide to clinical management of blood transfusions for patients receiving anti-CD38 monoclonal antibodies.
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Affiliation(s)
- Guido Lancman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Suzanne Arinsburg
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jeffrey Jhang
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Hearn Jay Cho
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Deepu Madduri
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Samir Parekh
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joshua Richter
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ajai Chari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Hosokawa M, Kashiwagi H, Nakayama K, Sakuragi M, Nakao M, Morikawa T, Kiyokawa T, Aochi H, Nagamine K, Shibayama H, Tomiyama Y. Distinct effects of daratumumab on indirect and direct antiglobulin tests: a new method employing 0.01 mol/L dithiothreitol for negating the daratumumab interference with preserving K antigenicity (Osaka method). Transfusion 2018; 58:3003-3013. [PMID: 30267414 DOI: 10.1111/trf.14900] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is an increasing demand for daratumumab (DARA), an immunoglobulin (Ig)G1κ monoclonal antibody (MoAb) that recognizes CD38, to manage relapsed or refractory multiple myeloma (MM) patients. However, DARA leads to positive and panreactive agglutination reactions in indirect antiglobulin tests (IATs) in vitro (the DARA interference). In addition, effects of DARA on red blood cells (RBCs) in vivo remains elusive. STUDY DESIGN AND METHODS To develop a new method to negate the DARA interference, the effects of various concentrations of dithiothreitol (DTT) on RBC CD38 and Kell antigenicity in combination with an automatic blood cell washing centrifuge were compared with the AABB standard procedure in parallel. Moreover, direct antiglobulin tests (DATs) for RBCs in DARA-treated MM patients were examined. RESULTS A quantity of 0.01 mol/L DTT as well as the AABB procedure (equivalent to 0.15 mol/L DTT in our procedure) markedly reduced the reactivity of phycoerythrin-mouse anti-CD38 MoAb and DARA with RBCs. In sharp contrast to the AABB procedure, 0.01 mol/L DTT partially preserved K antigenicity and allowed the determination of phenotype of K antigen even in the presence of the DARA interference. In contrast, DAT for RBCs obtained from MM patients showed a weak positive or negative reaction. Immunoblotting further indicated that DARA induced loss of CD38 in vivo. CONCLUSION A simple and reliable method to negate the DARA interference with partially preserving Kell antigenicity is proposed (Osaka method). CD38 antigenicity is susceptible to 0.01 mol/L DTT treatment even in the presence of DARA. Our data also demonstrate distinct effects of DARA on IAT in vitro and DAT in vivo.
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Affiliation(s)
- Mika Hosokawa
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, Japan
| | - Hirokazu Kashiwagi
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | | | - Mikiko Sakuragi
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, Japan
| | - Mayumi Nakao
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, Japan
| | - Tamayo Morikawa
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, Japan
| | - Tomoko Kiyokawa
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, Japan
| | - Hiroshi Aochi
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, Japan
| | - Keisuke Nagamine
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, Japan
| | - Hirohiko Shibayama
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiaki Tomiyama
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, Japan.,Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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