Department of Blood Transfusion, Tianjin Medical University General Hospital, Tianjin, China.
Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China.
Leuk Res. 2022 Nov;122:106953. doi: 10.1016/j.leukres.2022.106953. Epub 2022 Sep 17.
To investigate the effect of anti-CD38 monoclonal antibodies (mAb) (daratumumab, DARA) and anti-CD47 mAb combined with azacytidine on blood transfusion compatibility tests, transfusion effects in the treatment of multiple myeloma or acute myeloid leukemia and the corresponding management strategy.
Among the 19 patients who were treated with DARA and anti-CD47 mAb, 4 patients with cross matching incompatibility were selected. The ABO blood group, the Rh blood group, irregular antibody screening and direct antiglobulin test (DAT) and cross matching testing were performed before and after the application of mAbs using serological methods. Then, irregular antibody screening and microcolumn gel cross matching tests were performed with donor and recipient erythrocytes and serum treated with DL-dithiothreitol (DTT) and Immucor kit, respectively. The transfusion effect was monitored.
21.05% (4/19) patients had mismatched cross-matching results after mAb treatment. The agglutination intensity of irregular antibody screening tests (3 + ∼ 4 +) after anti-CD47 mAb was higher than that (1 + ∼ 2 +) after DARA. In the DARA group, treating RBCs with 0.2 mol L DTT eliminated the DARA interference with antibody screening. In the anti-CD47 mAb group, the antibody screening, cross-matching test and DAT had been strongly interfered, and using Immucor kit eliminated the interference with antibody screening testing. There was no difference in the transfusion effect.
The application of mAb drugs led to incompatibility of cross matching tests, and the transfusion effect was not affected.
研究抗 CD38 单克隆抗体（mAb）（达雷妥尤单抗，DARA）和抗 CD47 mAb 联合阿扎胞苷对输血相容性试验、多发性骨髓瘤或急性髓系白血病治疗中的输血效果的影响及其相应的管理策略。
在接受 DARA 和抗 CD47 mAb 治疗的 19 例患者中，选择了 4 例交叉配血不合的患者。采用血清学方法，在应用 mAbs 前后分别进行 ABO 血型、Rh 血型、不规则抗体筛查和直接抗球蛋白试验（DAT）及交叉配血试验。然后，分别用 DL-二硫苏糖醇（DTT）和 Immucor 试剂盒处理供者和受者红细胞及血清，进行不规则抗体筛查和微柱凝胶交叉配血试验，并监测输血效果。
19 例患者中有 21.05%（4/19）在 mAb 治疗后出现交叉配血不合的结果。抗 CD47 mAb 后不规则抗体筛查试验的凝集强度（3+～4+）高于 DARA 后（1+～2+）。在 DARA 组中，用 0.2mol/L DTT 处理 RBC 可消除 DARA 对抗体筛查的干扰。在抗 CD47 mAb 组中，抗体筛查、交叉配血试验和 DAT 已受到强烈干扰，使用 Immucor 试剂盒可消除对抗体筛查试验的干扰。输血效果无差异。
mAb 药物的应用导致交叉配血试验不合，但不影响输血效果。
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