Department of Pathology, University of California San Diego, La Jolla, California, USA.
Division of Blood and Marrow Transplantation, University of California San Diego, La Jolla, California, USA.
Transfusion. 2021 Jul;61(7):2054-2063. doi: 10.1111/trf.16425. Epub 2021 May 7.
Daratumumab, a human anti-CD38 monoclonal antibody used to treat multiple myeloma, interferes with pretransfusion testing and can mask alloantibodies. Incidence of alloimmunization in patients on daratumumab has not been well characterized, and optimal transfusion guidelines regarding prophylactic antigen matching, accounting for both patient safety and efficiency, have not been well established for these patients.
Records of patients who received daratumumab between January 1, 2014 and July 2, 2019 were reviewed. Daratumumab interference with pretransfusion testing was managed by testing with reagent red blood cells (RBCs) treated with 0.2 M dithiothreitol. When daratumumab was present during antibody testing, patients were transfused with RBC units prophylactically matched for D, C, c, E, e, and K antigens per hospital policy.
Out of 90 patients identified, 52 received a total of 638 RBC transfusions (average of 12.3 units per patient, SD 17.2, range 1-105, median 5 among those transfused). Alloantibodies existing before daratumumab initiation were identified in seven patients. No new alloantibodies were detected in any patients after starting daratumumab treatment.
The incidence of alloimmunization in patients receiving daratumumab is low. Whether this is due to the effect of daratumumab, underlying pathophysiology, or other factors, is unknown. Because these patients require a large number of RBC transfusions overall and have little observed alloimmunization, phenotype matching (beyond RhD) may be unnecessary. Since the use of dithiothreitol cannot rule out the presence of anti-K, we recommend transfusion of ABO-compatible units, prophylactically matched for the D and K antigens only.
达雷妥尤单抗是一种用于治疗多发性骨髓瘤的人源抗 CD38 单克隆抗体，它会干扰输血前检测，并可能掩盖同种抗体。接受达雷妥尤单抗治疗的患者发生同种免疫的发生率尚未得到很好的描述，并且针对这些患者，尚未制定出关于预防性抗原匹配的最佳输血指南，以兼顾患者安全和效率。
回顾了 2014 年 1 月 1 日至 2019 年 7 月 2 日期间接受达雷妥尤单抗治疗的患者的记录。用 0.2M 二硫苏糖醇处理的试剂红细胞（RBC）进行检测，以处理达雷妥尤单抗对输血前检测的干扰。当抗体检测中存在达雷妥尤单抗时，根据医院政策，预防性地为患者输注与 D、C、c、E、e 和 K 抗原相匹配的 RBC 单位。
在确定的 90 名患者中，有 52 名共接受了 638 次 RBC 输血（平均每位患者 12.3 个单位，标准差 17.2，范围 1-105，中位数为 5，在接受输血的患者中）。在开始达雷妥尤单抗治疗前，有 7 名患者存在同种抗体。在开始接受达雷妥尤单抗治疗后，没有任何患者检测到新的同种抗体。
接受达雷妥尤单抗治疗的患者发生同种免疫的发生率较低。这是由于达雷妥尤单抗的作用、潜在的病理生理学原因还是其他因素所致尚不清楚。由于这些患者总体上需要大量的 RBC 输血，且观察到的同种免疫反应很少，因此可能不需要表型匹配（超出 RhD）。由于二硫苏糖醇的使用不能排除抗-K 的存在，因此我们建议输注 ABO 相容的单位，仅预防性地匹配 D 和 K 抗原。
