Compatibility testing and blood transfusion in the treatment with anti-CD38 monoclonal antibody
Mirela Raos, Ines Bojanić, Sandra Bašić Kinda, Josip Batinić, Branka Golubić Ćepulić
Daratumumab is the first anti-CD38 monoclonal antibody used for the treatment of multiple myeloma. Its application causes pan-reactivity in the pre-transfusion testing. The pan-reactivity is a result of anti-CD38 monoclonal antibody binding to CD38 protein on the red blood cell surface, which in standard testing makes it impossible to detect red blood cell alloantibodies and to provide compatible blood for transfusion. The aim of the study was to retrospectively analyze our experience in solving anti-CD38 monoclonal antibody interference with the pre-transfusion testing of these patients. The procedures for pre-transfusion testing and blood transfusion of patients treated with anti-CD38 monoclonal antibody carried out in the Clinical Hospital Center Zagreb are presented. The study analysed ten patients treated with daratumumab. Before and after daratumumab treatment, red blood cell antibody screening test and direct antiglobulin test were done. In the case of blood transfusion, red blood cell antibody screening test and cross-matches were performed by standard testing and specific immunohematological procedures to eliminate anti-CD38 monoclonal antibody interference. Procedures included red blood cell treatment with 0.2 M dithiothreitol and neutralization test using DaraEx reagent. In all patients red blood cell antibody screening tests and cross-matches were positive after daratumumab treatment, whereas a direct antiglobulin test, for daratumumab treatment, was positive in almost half of the patients. After treatment of red blood cells with 0.2 M dithiothreitol, the incidence of false positive results in the antibody screening test and the cross-matches was approximately 40%, and after DaraEx reagent approximately 20%. Both specific procedures, red blood cell treatment with 0.2 M dithiotreitol and neutralization test using DaraEx reagent have not been shown to be sufficiently reliable in addressing the interference caused by the anti-CD38 monoclonal antibody. Therefore, for blood transfusion of these patients it is necessary to provide red blood cell units matched with the most significant Rh, Kell, Kidd, Duff and MNS blood group systems. Good collaboration between the ward and the transfusion service, with protocols in place for pre-transfusion testing and blood transfusion, remains a precondition for timely and safe blood transfusion for this group of patients.