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Purpose <p>Daratumumab (DARA), an anti-CD38 monoclonal antibody used in multiple myeloma (MM), interferes with pretransfusion testing by binding to CD38 on red blood cells, resulting in pan-reactivity and crossmatch incompatibility. This poses significant transfusion challenges, particularly in resource-limited settings where mitigation strategies are underutilized. This study aimed to evaluate the immunohematological interference caused by DARA and assess the effectiveness of a modified low-concentration dithiothreitol (DTT) protocol in resolving antibody screen pan-reactivity and restoring crossmatch compatibility.</p> Methods <p>A retrospective study was conducted on 43 DARA-treated MM patients between 2019 and 2024 at a tertiary care center in Eastern India. Antibody screening, crossmatching, and DTT-treated testing were performed using column agglutination technology. A modified 0.01&#xa0;M DTT protocol was developed and validated locally to optimize red cell integrity and minimize reagent use.</p> Results <p>All patients showed positive antibody screens, with 97.7% exhibiting pan-reactivity and AHG crossmatch incompatibility. DTT treatment resolved reactivity in all cases, with crossmatch compatibility achieved in 42 patients (97.7%). One anti-E alloantibody was identified. A total of 79 red cell units were transfused (mean: 1.84 units/patient), yielding a mean hemoglobin rise of 0.99&#xa0;g/dL. One mild transfusion reaction occurred. The average turnaround time for DTT processing was 125.9&#xa0;min.</p> Conclusion <p>This study demonstrates that a modified low-concentration DTT protocol effectively neutralizes DARA-induced interference while preserving red cell integrity. The method is feasible, cost-efficient, and safe for implementation in Indian transfusion services, supporting improved transfusion management in DARA-treated patients.</p>

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Resolving Daratumumab-Induced Serologic Interference: A Modified Low-Concentration DTT Protocol in Multiple Myeloma Patients in Eastern India

  • 期刊论文

  • 发表日期：

    2025年10月27日

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  • Sudipta Sekhar Das,
  • Sourav Mukherjee,
  • Sourav Chowdhury,
  • Mahammad Safi,
  • Arjin Philips Jacoby,
  • Anupam Chakrapani

摘要

Purpose

Daratumumab (DARA), an anti-CD38 monoclonal antibody used in multiple myeloma (MM), interferes with pretransfusion testing by binding to CD38 on red blood cells, resulting in pan-reactivity and crossmatch incompatibility. This poses significant transfusion challenges, particularly in resource-limited settings where mitigation strategies are underutilized. This study aimed to evaluate the immunohematological interference caused by DARA and assess the effectiveness of a modified low-concentration dithiothreitol (DTT) protocol in resolving antibody screen pan-reactivity and restoring crossmatch compatibility.

Methods

A retrospective study was conducted on 43 DARA-treated MM patients between 2019 and 2024 at a tertiary care center in Eastern India. Antibody screening, crossmatching, and DTT-treated testing were performed using column agglutination technology. A modified 0.01 M DTT protocol was developed and validated locally to optimize red cell integrity and minimize reagent use.

Results

All patients showed positive antibody screens, with 97.7% exhibiting pan-reactivity and AHG crossmatch incompatibility. DTT treatment resolved reactivity in all cases, with crossmatch compatibility achieved in 42 patients (97.7%). One anti-E alloantibody was identified. A total of 79 red cell units were transfused (mean: 1.84 units/patient), yielding a mean hemoglobin rise of 0.99 g/dL. One mild transfusion reaction occurred. The average turnaround time for DTT processing was 125.9 min.

Conclusion

This study demonstrates that a modified low-concentration DTT protocol effectively neutralizes DARA-induced interference while preserving red cell integrity. The method is feasible, cost-efficient, and safe for implementation in Indian transfusion services, supporting improved transfusion management in DARA-treated patients.