Antibody incidence and red blood cell transfusions in patients on daratumumab

Abstract

Background: Daratumumab (Dara), an anti-CD38 monoclonal antibody for hematologic malignancies, interferes with routine blood bank testing, specifically affecting the antibody screen and identification panels. In 2016, the AABB recommended performing a baseline phenotype or genotype before a patient (Pt) begins taking anti-CD38 to avoid this interference and potential problems with transfusion. The objective of this study was to assess red blood cell (RBC) utilization and subsequent incidence of alloimmunization to the transfused RBCs in patients receiving Dara. Methods and Materials:We monitored 244 patients taking Dara to determine their red blood cell transfusions and incidence of clinically significant antibody formation before and following administration of Dara. Poisson generalized estimating equations with log link were used comparing the post-Dara incidence and prevalence to those prior, with significance defined as p < .05. Results:From September 1, 2015 to December 22, 2018, 244 patients on Dara were identified, of which 145 patients (59.4%) received a red blood cell transfusion. Antibody screens were performed on 97 of the 145 patients at least 2 weeks following RBC transfusion. Four of the total transfused patients (2.8% total, 4.1% patients with follow-up antibody screen testing) formed new clinically significant alloantibodies, which was not significantly different from Asare's hematologic incidence (p = .98/p = .49).Conclusions: This study showed our patients on Dara did not form alloantibodies following RBC transfusion at a higher incidence than similar patient populations.

Detection of unexpected antibodies in Korean multiple myeloma patients on daratumumab using dithiothreitol‐treated reagent cells is more efficient than extended phenotyping and genotyping

“…To the Editor, Recently, Tauscher et al reported that the number of patients with multiple myeloma (MM) on daratumumab forming subsequent red blood cell (RBC) alloantibodies was not as great as expected. 1 According to this study, out of the 244 patients with MM, only four (4/244, 1.6%) exhibited newly formed RBC alloantibodies. Also, the incidence and prevalence of RBC alloimmunization were lower than random patients (2.9%) or patients with other hematologic diseases (2.8%).…”

Interference Analysis of Monoclonal Antibody Cluster of Differentiation 38 on ABO Blood Group Identification and Cross-Matching

“…Among them, 98 cases of MM, 22 cases of chronic lymphocytic leukemia and 16 cases of relapsed acute myeloid leukemia as shown in Table 1. CD38 monoclonal antibody is daratumab [14][15][16][17][18] . In addition to daratumab (Janssen Biotech), other anti-CD38 drugs currently in Phase 1 or 2 clinical trials include MOR202 (MorPhoSys), isatuximab (Sanofi-Aventis) and TAK-079 (Takeda), which were adopted for systemic lupus erythematosus or other autoimmune diseases treatment.…”

Efficient neutralization of daratumumab in pretransfusion samples using a novel recombinant monoclonal anti‐idiotype antibody

“…However, most of the residual risk is avoided by providing K-matched units, which is not difficult, as approximately 91% of donor units are K-negative. 20 In practice, patients receiving anti-CD38 have a low incidence of RBC alloimmunization, [22][23][24] and with the availability of the DTT method and other effective mitigation strategies, delayed hemolytic transfusion reactions have rarely, if ever, been observed among anti-CD38 recipients. 25 Perhaps the most important limitation of the DTT method is that it requires meaningful technologist time and effort.…”