Dr. Rick Kaufman from Brigham and Women’s Hospital in Boston joins Dr. Chaffin to discuss resolving the anti-CD38 interference with blood compatibility testing. Since the multiple myeloma drug with the funny name, “daratumumab” (or just “DARA”), was approved in the United States in late 2015, there have been many words said about “communication” and “DTT” and “panagglutinins,” but many blood bankers are still confused. Dr. Kaufman is an international expert on how to deal with the interference that this drug (which is really just an antibody!) has on pretransfusion testing, and he generously shares what he has learned from extensive work on this issue in his transfusion service and laboratory. Therapies such as this are becoming the norm in medicine, and blood banks can expect to deal with these issues more and more often, so have a listen and get ready!
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Dr. Kaufman would like you to know that he has received reagents and research funding from Janssen, Inc, and that he serves as a consultant for Janssen.
Images 1-5 below are generously provided by Dr. Kaufman. Especially note slide 4, which is really the key to understanding why DARA causes a problem for pretransfusion testing. Slide 6 is a bonus from me showing the shared CD38 expression on plasma cells and red cells.
- 02:45: Intro to Dr. Kaufman
- 06:44: Why DARA? What’s the need?
- 10:40: Terminology check; What does “-mab” mean?
- 12:00: Patients approved for DARA in the U.S. today (+ other diseases being studied)
- 14:20: Is DARA working for myeloma?
- 16:00: What is a course of DARA?
- 17:37: Why blood bankers should care about DARA
- 24:00: Dr. Kaufman’s lab work on DARA
- 32:00: DTT use to remove DARA effect; potential hazards
- 35:38: Perfect world strategy for patients on DARA
- 42:35: Choosing RBCs for DARA patients
- 45:07: DTT vs. Trypsin to remove CD38
- 50:35: The blood bank future with monoclonal antibody therapy
- Chapuy CI et al. Resolving the daratumumab interference with blood compatibility testing. Transfusion 2015;55;1545–1554.
- Oostendorp M et al. When blood transfusion medicine becomes complicated due to interference by monoclonal antibody therapy. Transfusion 2015;55;1555–1562.
- AABB Association Bulletin 16-02. Mitigating the Anti-CD38 Interference with Serologic Testing. January 15, 2016.
- Darzalex prescribing information. https://www.darzalex.com/shared/product/darzalex/darzalex-prescribing-information.pdf (accessed 05/28/2016).