Deneys V, Thiry C, Frelik A, Debry C, Martin B, Doyen C
Blood Transfusion Service, CHU UCL Namur, 5530 Yvoir, Belgium.
Blood Transfusion Service, CHU UCL Namur, 5530 Yvoir, Belgium.
Transfus Clin Biol. 2018 Feb;25(1):2-7. doi: 10.1016/j.tracli.2017.12.001. Epub 2018 Jan 12.
Recently, daratumumab has been included in the therapeutic strategies for myeloma patients. This molecule is an antibody directed against CD38, strongly expressed on plasma cells. Nevertheless, as CD38 is also present on erythrocyte membrane, daratumumab interferes with immunohaematological tests, complicating the selection of compatible blood.
A total of 14 patients treated by daratumumab have been followed in our transfusion laboratory. Among them, 11 have been transfused. Dithiotreitol (DTT) has been used to inhibit the daratumumab's interference, in the pre-transfusion tests (irregular antibody screening and cross-match).
The red blood cell treatment with DTT has been very efficacious to inhibit the daratumumab's interference in 13 patients out of 14. Some precautionary measures had to be taken into account, especially the pH and the storage conditions. An extended pheno/genotype was an additional security element in the selection of compatible blood. To simplify and to optimize the laboratory practices, a decisional flow chart has been written.
DTT red blood cell treatment is very useful and efficacious in the pre-transfusion tests of patients treated with daratumumab. It allows to avoid the selection of blood bags only on the basis of an extended pheno/genotype, what is more secure and more ethical with respect to other at higher risk patients. A clear decisional flow chart allows a quality assurance gait. Collaboration with physicians is essential.
最近，达雷妥尤单抗已被纳入骨髓瘤患者的治疗策略中。该分子是一种针对CD38的抗体，CD38在浆细胞上强烈表达。然而，由于CD38也存在于红细胞膜上，达雷妥尤单抗会干扰免疫血液学检测，使相容血液的选择变得复杂。
我们的输血实验室对总共14例接受达雷妥尤单抗治疗的患者进行了随访。其中，11例接受了输血治疗。在输血前检测（不规则抗体筛查和交叉配血）中，使用二硫苏糖醇（DTT）来抑制达雷妥尤单抗的干扰。
用DTT处理红细胞对抑制达雷妥尤单抗的干扰非常有效，14例患者中有13例有效。必须考虑一些预防措施，特别是pH值和储存条件。扩展的表型/基因型是选择相容血液时的一个额外安全因素。为了简化和优化实验室操作，制定了一个决策流程图。
DTT处理红细胞在接受达雷妥尤单抗治疗患者的输血前检测中非常有用且有效。它可以避免仅基于扩展的表型/基因型来选择血袋，这对于其他高风险患者来说更安全、更符合伦理。清晰的决策流程图有助于保证质量。与医生的合作至关重要。
