Nedumcheril Marilyn T, DeSimone Robert A, Racine-Brzostek Sabrina E, Chaekal Ok Kyong, Vasovic Ljiljana V
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.
J Blood Med. 2021 May 25;12:327-336. doi: 10.2147/JBM.S213510. eCollection 2021.
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.
达雷妥尤单抗是一种单克隆抗体疗法，具有高效性，广泛应用于多发性骨髓瘤和淀粉样变性的各个阶段，并且在其他血液系统疾病中也具有良好的活性。达雷妥尤单抗与红细胞相互作用，干扰输血前检测。这种干扰可能会危及输血安全，导致血库进行大量检查，并延误提供相容的血液单位。已经开发出几种方法来消除达雷妥尤单抗对间接抗球蛋白试验的干扰。这些方法基于：i）标准血库技术，包括使用对CD38呈阴性的试剂红细胞进行二硫苏糖醇和酶处理试剂细胞；ii）封闭试剂或供体细胞上的CD38抗原；iii）在检测前中和患者血浆中的抗CD38抗体；iv）对患者红细胞进行扩展抗原分型，并提供表型匹配的血液单位进行输血。血库实施这些方法应该是与患者临床团队协调的有计划的工作。血库和输血服务部门的及时参与以及血库和临床提供者的教育工作可以改善达雷妥尤单抗在输血方面的整体安全性。
