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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">bloodjour</journal-id><journal-title-group><journal-title xml:lang="ru">Гематология и трансфузиология</journal-title><trans-title-group xml:lang="en"><trans-title>Russian journal of hematology and transfusiology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">0234-5730</issn><issn pub-type="epub">2411-3042</issn><publisher><publisher-name>ООО Издательский дом «Практика»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.25837/HAT.2018.45..1..004</article-id><article-id custom-type="elpub" pub-id-type="custom">bloodjour-85</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group></article-categories><title-group><article-title>МОДИФИКАЦИЯ ПРЕАНАЛИТИЧЕСКОГО ЭТАПА НЕПРЯМОЙ ПРОБЫ КУМБСА У БОЛЬНЫХ МНОЖЕСТВЕННОЙ МИЕЛОМОЙ ПРИ ЛЕЧЕНИИ ДАРАТУМУМАБОМ</article-title><trans-title-group xml:lang="en"><trans-title>A MODIFICATION OF THE PRE-ANALYTICAL PHASE OF THE INDIRECT COOMBS TEST FOR MULTIPLE MYELOMA PATIENTS TREATED WITH DARATUMUMAB</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Головкина</surname><given-names>Л. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Golovkina</surname><given-names>L. L.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Головкина Лариса Леонидовна, д. м. н., заведующая лабораторией трансфузиологической иммуногематологии</p><p>ResearcherID: M-6316-2014; Scopus Author ID: 6602579655; SPIN-код: 1934-4336; AuthorID: 605358 </p></bio><bio xml:lang="en"><p>Golovkina Larisa L., MD, PhD, DSc, head of laboratory of transfusiological immunohematology, National Research Center for Hematology, Moscow, 125165</p><p>ResearcherID: M-6316-2014; Scopus Author ID: 6602579655; SPIN-код: 1934-4336; AuthorID: 605358 </p></bio><email xlink:type="simple">largol@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7137-8877</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Минеева</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Mineeva</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"/><bio xml:lang="en"/><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Менделеева</surname><given-names>Л. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Mendeleeva</surname><given-names>L. P.</given-names></name></name-alternatives><bio xml:lang="ru"/><bio xml:lang="en"/><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бессмельцев</surname><given-names>С. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Bessmelzev</surname><given-names>S. S.</given-names></name></name-alternatives><bio xml:lang="ru"/><bio xml:lang="en"/><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Стремоухова</surname><given-names>A. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Stremoukhova</surname><given-names>A. G.</given-names></name></name-alternatives><bio xml:lang="ru"/><bio xml:lang="en"/><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Грибанова</surname><given-names>Е. О.</given-names></name><name name-style="western" xml:lang="en"><surname>Gribanova</surname><given-names>E. O.</given-names></name></name-alternatives><bio xml:lang="ru"/><bio xml:lang="en"/><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Соловьев</surname><given-names>М. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Solovyev</surname><given-names>M. V.</given-names></name></name-alternatives><bio xml:lang="ru"/><bio xml:lang="en"/><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБУ «Национальный медицинский исследовательский центр гематологии» Министерства здравоохранения России, Москва</institution><country>Россия</country></aff><aff xml:lang="en"><institution>National Research Center for Hematology, Moscow</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБУ «Российский НИИ гематологии и трансфузиологии» ФМБА России, Санкт-Петербург</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Russian Research Institute of Hematology and Transfusiology, St. Petersburg</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2018</year></pub-date><pub-date pub-type="epub"><day>18</day><month>04</month><year>2019</year></pub-date><volume>63</volume><issue>1</issue><fpage>44</fpage><lpage>54</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Головкина Л.Л., Минеева Н.В., Менделеева Л.П., Бессмельцев С.С., Стремоухова A.Г., Грибанова Е.О., Соловьев М.В., 2019</copyright-statement><copyright-year>2019</copyright-year><copyright-holder xml:lang="ru">Головкина Л.Л., Минеева Н.В., Менделеева Л.П., Бессмельцев С.С., Стремоухова A.Г., Грибанова Е.О., Соловьев М.В.</copyright-holder><copyright-holder xml:lang="en">Golovkina L.L., Mineeva N.V., Mendeleeva L.P., Bessmelzev S.S., Stremoukhova A.G., Gribanova E.O., Solovyev M.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.htjournal.ru/jour/article/view/85">https://www.htjournal.ru/jour/article/view/85</self-uri><abstract><p>Резюме. Для лечения больных множественной миеломой (ММ), рефрактерной к терапии ингибиторами протеасом и иммуномодулирующими препаратами, применяют таргетные моноклональные антитела к CD38, поскольку маркер CD38 обладает выраженной экспрессией на злокачественных плазматических клетках. Однако белок CD38 в незначительном количестве представлен на эритроцитах. Взаимодействие терапевтических антител к CD38 с эритроцитами приводит к появлению CD38-специфической агглютинации в некоторых иммуногематологических тестах. Цель исследования: отработать и адаптировать методику устранения CD38-специфической агглютинации в антиглобулиновом тесте путем обработки эритроцитов дитиотреитолом. Задачи исследования: изучить антипенный профиль эритроцитов до и после обработки дитиотреитолом; изучить иммуногематологические характеристики сывороток и эритроцитов больных ММ, получающих антитела к CD38. Материалы и методы: исследовали сыворотки и эритроциты 9 больных ММ до и в процессе лечения антителами к CD38, применяя стандартные эритроциты 3- и 11-клеточной панелей, эритроциты доноров компонентов крови. Антигенный профиль эритроцитов до и после обработки их дитиотреитолом изучали методом гемагглютинации. Результаты: метод обработки эритроцитов дитиотреитолом воспроизведен и адаптирован к условиям работы специалистов клинической лабораторной диагностики Российской Федерации. Отработаны нюансы применения дитиотреитола. Показана эффективность дитиотреитола при устранении CD38-специфической агглютинации в иммунологических тестах у больных ММ, получавших антитела к CD38. Показано, что у всех больных аутоконтроль, прямая проба Кумбса были отрицательными до и после введения антител к CD38. Результаты пробы на совместимость между сывороткой больного и донорскими эритроцитами, выполняемые в непрямом антиглобулиновом тесте, результаты скрининга аллоиммунных антиэритроцитарных антител у больных на фоне проводимого лечения антителами к CD38 можно было оценивать только после обработки планируемых к переливанию эритроцитов и тест-эритроцитов дитиотреитолом. Без обработки дитиотреитолом CD38-специфическую агглютинацию в гелевых картах LISS/Coombs оценивали на 1+ — 2+. Лечение антителами к CD38 не мешало проведению расширенного фенотипирования эритроцитов с использованием реактивов на основе полных специфических антител (систем АВО, Резус, Келл, MNS, Даффи). Заключение: дитиотреитол позволяет устранять CD38- специфическую агглютинацию у больных ММ, получающих терапию антителами к CD38.</p></abstract><trans-abstract xml:lang="en"><p>Abstract. Daratumumab, the first therapeutic monoclonal antibody that binds to CD38, is used for treatment of patients with multiple myeloma. The CD38 transmembrane protein is highly expressed on the surface of malignant myeloma cells, but also, to a lesser extent, is expressed by many other types of cells, including red blood cells (RBCs). When daratumumab binds to CD38 expressed on RBCs, this may result in positive indirect antiglobulin tests (IAT) performed to identify immunological compatibility before RBC transfusions. Anti-CD38-specific agglutination may also variably affect autocontrol, direct antiglobulin test (DAT), and eluate tests. The aim of the study was to develop a protocol for preventing CD38-specific agglutination in antiglobulin tests by treatment of RBCs with dithiothreitol (DTT). Materials and methods. Between July 2016 and April 2017, 9 multiple myeloma patients undergoing daratumumab treatment were tested using routine methods in the Immunohematology Laboratory of the National Hematological Research Center in Moscow. The tests included ABO and Rh typing, extended phenotype matching, DAT, and IAT in LISS/Coombs gel cards. Tests were performed before and after treatment of RBCs with DTT. Results. No daratumumab interference was observed in ABO, Rh, Kell, MNS or Fy typing with IgM antibodies. DAT and auto control were also negative in all patients. On the other hand, all patients showed daratumumabmediated positive IAT, which was resolved by treatment of RBCs with DTT. Conclusions. Anti-CD38 antibodies interfere with serological tests. This interference can be resolved by treating RBCs with DTT. Blood banks and immunohematological laboratories should be informed that a patient is receiving treatment with anti-CD38.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>иммуногематологические исследования</kwd><kwd>антиглобулиновый тест непрямой и прямой</kwd><kwd>пробы на совместимость</kwd><kwd>аллоиммунные антитела</kwd><kwd>эритроцит</kwd><kwd>CD38</kwd><kwd>антитела к CD38</kwd><kwd>множественная миелома</kwd><kwd>таргетная терапия</kwd><kwd>дитиотреитол</kwd><kwd>антигены эритроцитарных систем</kwd></kwd-group><kwd-group xml:lang="en"><kwd>immunohematological tests</kwd><kwd>direct antiglobulin test</kwd><kwd>indirect antiglobulin test</kwd><kwd>blood compatibility tests</kwd><kwd>red blood cells</kwd><kwd>alloimmune antibodies</kwd><kwd>CD38</kwd><kwd>anti-CD38 antibodies</kwd><kwd>multiple myeloma</kwd><kwd>target therapy</kwd><kwd>dithiothreitol</kwd><kwd>red blood cell antigens</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Kumar S, Lee J, Lahuerta J et al. 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