A MODIFICATION OF THE PRE-ANALYTICAL PHASE OF THE INDIRECT COOMBS TEST FOR MULTIPLE MYELOMA PATIENTS TREATED WITH DARATUMUMAB
https://doi.org/10.25837/HAT.2018.45..1..004
Abstract
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.
About the Authors
L. L. GolovkinaRussian Federation
Golovkina Larisa L., MD, PhD, DSc, head of laboratory of transfusiological immunohematology, National Research Center for Hematology, Moscow, 125165
ResearcherID: M-6316-2014; Scopus Author ID: 6602579655; SPIN-код: 1934-4336; AuthorID: 605358
N. V. Mineeva
Russian Federation
SPIN-код: 7528-9460; AuthorID: 691696
L. P. Mendeleeva
Russian Federation
Scopus Author ID: 6701562648; ResearcherID: H-7845-2016; SPIN-код: 2564-2246; AuthorID: 122877
S. S. Bessmelzev
Russian Federation
SPIN-код: 4955-1364; AuthorID: 274497
A. G. Stremoukhova
Russian Federation
AuthorID: 715042
E. O. Gribanova
Russian Federation
SPIN-код: 3772-7386; AuthorID: 303138
M. V. Solovyev
Russian Federation
SPIN-код: 8939-0286; AuthorID: 963886
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Review
For citations:
Golovkina L.L., Mineeva N.V., Mendeleeva L.P., Bessmelzev S.S., Stremoukhova A.G., Gribanova E.O., Solovyev M.V. A MODIFICATION OF THE PRE-ANALYTICAL PHASE OF THE INDIRECT COOMBS TEST FOR MULTIPLE MYELOMA PATIENTS TREATED WITH DARATUMUMAB. Russian journal of hematology and transfusiology. 2018;63(1):44-54. (In Russ.) https://doi.org/10.25837/HAT.2018.45..1..004