Transfusion management in multiple myeloma patients receiving daratumumab: Experience of a single tertiary care centre.

Daratumumab (Dara) is a monoclonal antibody against CD38 that has shown high efficacy and safety profile in relapsed multiple myeloma (MM) patients as single agent and in combination with other antimyeloma agents. It has recently approved for front-line therapy in patients ineligible for hematopoietic stem cell transplantation [ [1] Nooka A.K. Kaufman J.L. Hofmeister C.C. Joseph N.S. Heffner T.L. Gupta V.A. et al. Daratumumab in multiple myeloma. Cancer. 2019; 125: 2364-2382 Crossref PubMed Scopus (67) Google Scholar ]. It is well recognized that Dara interferes with blood bank testing by binding to CD38 on red blood cells (RBC) and causing panagglutination in the Indirect Antiglobulin test (IAT). Chapuy et al [ [2] Chapuy C.I. Nicholson R.T. Aguad M.D. Chapuy B. Laubach J.P. Richardson P.G. et al. Resolving the daratumumab interference with blood compatibility testing. Transfusion. 2015; 55: 1545-1554 Crossref PubMed Scopus (158) Google Scholar ] reported that 0.2 M dithiothreitol (DTT) treatment of reagent RBCs can remove interference from DARA by disrupting the structure of the antigen but maintaining the capacity for the identification of underlying clinically significant alloantibodies. This test has been implemented and validated in large hospitals [ [3] Youssef M. Arnesen C. Arledge C. Langley C. Sylvester D. Sikora J. et al. Validation and cost-effectiveness of an in-house dithiothreitol (DTT) treatment protocol for daratumumab patients in a large tertiary care hospital provides gateway for implementation in smaller community hospitals. Transfus Apher Sci. 2019; 58: 152-155 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ]. However, DTT technique has several problems as time-consuming and destruction of some significant antigens as Kell. Due to these difficulties, not all blood Banks can have this test available. Then, it is proposed that a red blood cell extensive phenotype must be performed before starting daratumumab, in order to respect the antigen compatibility and avoid the development of clinically significant alloantibodies [ [4] Lancman G. Arinsburg S. Jhang J. Cho H.J. Jagannath S. Madduri D. et al. Blood transfusion management for patients treated with Anti-CD38 monoclonal antibodies. Front Immunol. 2018; 15: 2616 Crossref Scopus (28) Google Scholar ].