2-mercaptoethanol (2-ME)-based IATs or polybrene method mitigates the interference of anti-CD38 immunotherapy on blood compatibility tests

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Treating red blood cells (RBCs) with dithiothreitol (DTT) is a wildly-recommended to overcome the interference of anti-CD38 immunotherapy with blood compatibility testing. Nevertheless, DTT can be hard to obtain in clinical laboratory, while its use in routine practice may be time-consuming. In the following study, we explored the feasibility of using a commercial 2-mercaptoethanol (2-ME) working solution or the time-saving polybrene method to mitigate the daratumumab (DARA) interference.</jats:p> </jats:sec> <jats:sec> <jats:title>Materials and Methods</jats:title> <jats:p>Antibody screening and cross-matching were performed using 2-ME or DTT-based indirect antiglobulin tests (IATs) and polybrene method (human IgG anti-E same IATs titer as DARA as positive control) on 37 samples, and these samples were from patients enrolled in the “Several methods resolve the interference of anti-CD38 monoclonal antibody on blood compatibility tests” clinical trial (<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.chictr.org.cn">www.chictr.org.cn</jats:ext-link> identifier: ChiCTR2000040761). Most clinically important blood group antigens on RBCs were detected after treatment with 2-ME or DTT. Hemoglobin values were compared after 69 units RBCs were transfused with compatible cross-matching results by a 2-ME-based method or polybrene test.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Treating RBCs with 2-ME eliminates the DARA interference with the antibody screening or cross-matching; yet, K antigen is denatured during treatment. DARA with 2+ agglutinations of anti-E control does not interfere with antibody screening and cross-matching via polybrene method. After RBCs transfusion with a negative cross-matching test by 2-ME-based IATs or polybrene method, hemoglobin significantly increased without adverse transfusion reactions.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>2-ME-based IATs or polybrene method could be used to mitigate DARA interference as DTT.</jats:p> </jats:sec>