Alternative to DTT treating cells for ABSc when patients are treated with anti-CD38

[naomitolliver]

Hello everyone. At the AABB annual meeting I heard there is available a soluble CD38 substance that can be used to neutralize the anti-CD38 from therapy that interferes with routine antibody detection. I love the idea of not having to use DTT anymore since it is a very noxious chemical. Does anyone have experience with this method they would be willing to share? I am guessing it must be costly or most labs would be using it? Thanks in advance. 

[Ensis01]

News to me and sounds like great idea; cost and time depending 

[Arno]

I don't want to advertise any specific company but in this webinar available O-D (https://info.bio-rad.com/ww-IHD-transfusion-w6-registration-lp.html), various methods are discussed (pros/cons) on how to overcome the anti-CD38 interference. I thought it could be insteresting in the context of this thread.

[Neil Blumberg]

If you have access to cord red cells from your OB service, these are negative for CD38,  and we use a panel of three of them to rule out alloantibodies when patients are receiving daratumumab(Darzalex). 

 

Transfusion

. 2015 Sep;55(9):2292-3.

 doi: 10.1111/trf.13174.

[Joanne P. Scannell]

14 minutes ago, Neil Blumberg said:

If you have access to cord red cells from your OB service, these are negative for CD38,  and we use a panel of three of them to rule out alloantibodies when patients are receiving daratumumab(Darzalex). 

 

Transfusion

. 2015 Sep;55(9):2292-3.

 doi: 10.1111/trf.13174.

Do you perform all the antigen typing on your cord samples so you know which ones to use?!

[Joanne P. Scannell]

We have had good success with just lowering our sensitivity.  Example:  2+ Reactions in Gel can be negative in PEG ... Albumin ... or No Potentiator.

Rarely do we have to resort to DTT.

But an alternative sounds nice!  Thanks for the tip!

[Malcolm Needs ☆]

Remember that not all red cell antigens are expressed at adult levels.  By that, I don't mean just the well known weakness of the I antigen on cord red cells, but also the Lutheran antigens, the Lewis antigens and the antigens of the Chido/Rodgers Blood Group System.  Fortunately, antibodies directed against such antigens are rarely clinically significant, but it is worth being aware of the situation.

[Neil Blumberg]

Those are good points Malcom. We have yet to see any new alloimmunizations after >100 patients tested, probably because these patients have dramatically decreased B cell function.  Fortunately few of these patients need red cell transfusions as most of the new treatments for multiple myeloma, and there are many, are not causes of severe anemia.

[Neil Blumberg]

"Do you perform all the antigen typing on your cord samples so you know which ones to use?!"

 

Yes, we now actually use a four cell panel of frozen cord cells that last about a month in Alsever's solution once thawed.  We select cells so we have appropriate negatives and positives for the most important clinically significant antigens. We don't concern ourselves with Lewis, P, etc.  We do a full phenotype on the selected cells we use. Labor intensive but otherwise inexpensive.  

[naomitolliver]

On 11/30/2021 at 4:58 AM, Arno said:

I don't want to advertise any specific company but in this webinar available O-D (https://info.bio-rad.com/ww-IHD-transfusion-w6-registration-lp.html), various methods are discussed (pros/cons) on how to overcome the anti-CD38 interference. I thought it could be insteresting in the context of this thread.

Thank you for this link, it was very informative and current, which is what I am looking for. I recently read an article about using Trypsin treated cells and it sounded great, but the presenter of the Bio Rad webinar very clearly outlined the pros and cons of each method. 

I'm disappointed that the CD38 protein is only still available for research use only. With only minimal concerns for dilution, no noxious chemicals, and no destruction of Kell antigens it sounds like the perfect solution. I am very hopeful more labs will request more information of the company to encourage its use, soon.

 

Thanks again. NT