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

Background Anti-CD38 antibodies such as daratumumab (DARA) are critical therapies for multiple myeloma and other diseases. Unfortunately, anti-CD38 antibodies cause panreactivity in indirect antiglobulin tests (IATs), complicating blood compatibility testing. The anti-CD38 interference is most often mitigated by treating reagent red blood cells (RBCs) with dithiothreitol (DTT). However, when using the DTT method, not all RBC antibody specificities can be detected (e.g., anti-K), and the DTT method is impractical for some transfusion services. We evaluated the ability of a new anti-idiotype antibody to neutralize DARA in vitro and eliminate the anti-CD38 interference. Study Design and Methods A recombinant monoclonal rabbit anti-DARA idiotype antibody (anti-DARA) was generated. The ratio of anti-DARA required to neutralize DARA in spiked samples was evaluated in IATs performed in gel. IATs performed in tube were used to demonstrate that anti-DARA allows alloantibody detection in the presence of DARA. Plasma samples from 29 patients receiving DARA were treated with a fixed quantity of anti-DARA (120 mu g) before performing antibody detection tests (screens) in tube. Results Anti-DARA used at or above a 1:1 ratio with DARA eliminated the DARA interference with IATs. Anti-DARA allowed detection of both alloanti-E and alloanti-K in the presence of DARA. In 27/29 (93.1%) clinical samples, 120 mu g anti-DARA was sufficient to neutralize the DARA in 100 mu l patient plasma. Discussion An anti-DARA:DARA ratio as low as 1:1 is sufficient to neutralize DARA in solution. A fixed amount of anti-DARA eliminates the anti-CD38 interference in most patient samples.

Automated summary

The study evaluated a new anti-idiotype antibody's ability to neutralize DARA in vitro and eliminate anti-CD38 interference. Results showed that a 1:1 ratio of anti-DARA to DARA successfully eliminated interference in IATs and allowed detection of other alloantibodies. This new approach provides a promising solution for blood compatibility testing in patients receiving anti-CD38 therapy.