Management of laboratory interference associated with elotuzumab and CD38-targeting antibodies
| Laboratory test . | Antibody . | Management . |
|---|---|---|
| Interference with serum protein electrophoresis and immunofixation assays | Several therapeutic antibodies | DIRA should be performed when daratumumab-treated patients with IgG-κ M-protein have achieved deep response (M-protein <2 g/L) New assays are in development for elotuzumab, isatuximab and MOR202 |
| Interference with multiparametric flow cytometry | Daratumumab, isatuximab, MOR202, and possibly other therapeutic antibodies | Use of newly developed antibodies for flow cytometry, which bind to different epitopes compared with the therapeutic antibody Application of alternative plasma cell identification markers |
| Interference with blood compatibility testing | CD38-targeting antibodies (also observed with anti-CD44 antibodies) | Denaturation of CD38 from reagent RBCs by dithiothreitol Neutralization of therapeutic antibody with neutralizing antibodies or recombinant soluble CD38 Extensive RBC antigen phenotyping before the patient receives the first infusion of the CD38-targeting antibody or RBC antigen genotyping when the patient has already received treatment with an anti-CD38 antibody or a recent blood transfusion (<3 mo) A wallet card that informs physicians and blood banks of the interference with blood compatibility testing should be provided to all patients treated with CD38-binding antibodies |
| Laboratory test . | Antibody . | Management . |
|---|---|---|
| Interference with serum protein electrophoresis and immunofixation assays | Several therapeutic antibodies | DIRA should be performed when daratumumab-treated patients with IgG-κ M-protein have achieved deep response (M-protein <2 g/L) New assays are in development for elotuzumab, isatuximab and MOR202 |
| Interference with multiparametric flow cytometry | Daratumumab, isatuximab, MOR202, and possibly other therapeutic antibodies | Use of newly developed antibodies for flow cytometry, which bind to different epitopes compared with the therapeutic antibody Application of alternative plasma cell identification markers |
| Interference with blood compatibility testing | CD38-targeting antibodies (also observed with anti-CD44 antibodies) | Denaturation of CD38 from reagent RBCs by dithiothreitol Neutralization of therapeutic antibody with neutralizing antibodies or recombinant soluble CD38 Extensive RBC antigen phenotyping before the patient receives the first infusion of the CD38-targeting antibody or RBC antigen genotyping when the patient has already received treatment with an anti-CD38 antibody or a recent blood transfusion (<3 mo) A wallet card that informs physicians and blood banks of the interference with blood compatibility testing should be provided to all patients treated with CD38-binding antibodies |
DIRA, daratumumab interference reflex assay.