Eritzpokhoff Lara, Talegón De La Fuente Ernesto, Carril Barcia Aida, Asensi Cantó Pedro, Gómez Segui Ines, Arnao Herraiz Mario, De La Rubia Comos Javier, Solves Alcaina Pilar
Blood Bank and Hematology Department, Hospital La Fe, 46026 Valencia, Spain.
CIBERONC, Instituto Carlos III, Fundación para la Investigación del Hospital Universitario y Politécnico La Fe de la Comunidad Valenciana, Hospital La Fe, 46026 Valencia, Spain.
J Clin Med. 2025 Aug 14;14(16):5754. doi: 10.3390/jcm14165754.
Daratumumab is an anti-CD38 monoclonal antibody used in the treatment of multiple myeloma. Its use interferes with the indirect antiglobulin test (IAT). Treatment of reagent red blood cells (RBCs) with dithiothreitol (DTT) is one of the most validated techniques to resolve this interference. The objective of this study is to evaluate the rate of alloimmunization in transfused patients receiving daratumumab and the occurrence of hemolytic transfusion reactions. We conducted a single-center, retrospective, descriptive analysis of all patients treated with daratumumab at our institution from October 2016 to April 2024. For daratumumab-treated patients requiring RBC transfusions, an IAT with DTT-pretreated RBCs (DTT-IAT) was performed using the automated Orthovision system. Transfusion was administered only with a previous negative DTT-IAT while respecting Rh and Kell phenotyping. We assessed the transfusion profile of our patient cohort, including their rates of alloimmunization before and after daratumumab initiation, as well as the incidence of hemolytic complications. Additionally, a literature review was performed on reported alloimmunization rates in daratumumab-treated patients. Among all patients, 106 received RBC and/or platelet transfusions after starting daratumumab. Four had known pre-existing alloantibodies. None developed new alloantibodies or experienced hemolytic complications while receiving anti-CD38 therapy. There were four cases of false-positive DTT-IAT due to residual drug interference or technical variability, in which no alloantibodies or adverse transfusion reactions were detected. Patients receiving daratumumab exhibit a low risk of alloimmunization. This may be partly explained by adherence to Rh and Kell phenotyping and daratumumab's immunosuppressive effects on alloantibody production. These results support the conclusion that an extended red blood cell phenotype or genotype before starting daratumumab could be omitted if a fast and reliable technique for pretransfusion testing (such as automated DTT-IAT) is available 24 h.
达雷妥尤单抗是一种用于治疗多发性骨髓瘤的抗CD38单克隆抗体。它的使用会干扰间接抗球蛋白试验（IAT）。用二硫苏糖醇（DTT）处理试剂红细胞（RBC）是解决这种干扰的最有效技术之一。本研究的目的是评估接受达雷妥尤单抗治疗的输血患者的同种免疫发生率和溶血性输血反应的发生情况。我们对2016年10月至2024年4月在本机构接受达雷妥尤单抗治疗的所有患者进行了单中心、回顾性、描述性分析。对于需要输注红细胞的达雷妥尤单抗治疗患者，使用自动Orthovision系统进行DTT预处理红细胞的IAT（DTT-IAT）。仅在之前DTT-IAT结果为阴性且符合Rh和Kell血型分型的情况下才进行输血。我们评估了患者队列的输血情况，包括达雷妥尤单抗开始使用前后的同种免疫发生率以及溶血并发症的发生率。此外，还对报道的达雷妥尤单抗治疗患者的同种免疫发生率进行了文献综述。在所有患者中，106例在开始使用达雷妥尤单抗后接受了红细胞和/或血小板输血。4例已知存在预先存在的同种抗体。在接受抗CD38治疗期间，没有患者产生新的同种抗体或发生溶血并发症。有4例假阳性DTT-IAT病例，原因是残留药物干扰或技术差异，未检测到同种抗体或不良输血反应。接受达雷妥尤单抗治疗的患者同种免疫风险较低。这可能部分归因于遵循Rh和Kell血型分型以及达雷妥尤单抗对同种抗体产生的免疫抑制作用。这些结果支持这样的结论：如果有快速可靠的输血前检测技术（如自动DTT-IAT）且可在24小时内获得，那么在开始使用达雷妥尤单抗之前可以省略扩展的红细胞表型或基因型检测。
