Related Experiment Video
Updated: Aug 15, 2026
In Vitro Methods for Comparing Target Binding and CDC Induction Between Therapeutic Antibodies: Applications in Biosimilarity Analysis
Published on: May 4, 2017
Case report: serological testing interference of daratumumab (anti-CD38) therapy in multiple myeloma
Élodie Rabut1, Annabelle Castro-Fernandez1, Virginie Le Gall1
1Service d'hématologie, Laboratoire Biomnis, Ivry-sur-Seine, France.
Insights
Daratumumab immunotherapy can interfere with multiple myeloma diagnosis and treatment monitoring. This novel immunotherapy may cause misinterpretation of lab tests, including protein electrophoresis and red blood cell alloantibody screening.
Area of Science:
- Oncology
- Immunology
- Hematology
Background:
- Multiple myeloma is a hematologic malignancy characterized by uncontrolled proliferation of plasma cells.
- Refractory relapsed multiple myeloma requires novel therapeutic strategies, including immunotherapy.
- Daratumumab, an anti-CD38 monoclonal antibody, is a key immunotherapy for multiple myeloma.
Observation:
- A 54-year-old patient with refractory relapsed multiple myeloma received daratumumab immunotherapy.
- Daratumumab administration presented challenges in interpreting standard laboratory diagnostics.
- Interference was observed in serum protein electrophoresis, immunofixation, and red blood cell alloantibody screening.
Findings:
- Daratumumab, as an IgG1 kappa antibody, can mimic a monoclonal IgG kappa light chain peak on electrophoresis and immunofixation.
- The anti-CD38 activity of daratumumab interferes with CD38-expressing red blood cell reagents used in alloantibody screening.
- Dithiotreitol was successfully used to overcome the interference in red blood cell alloantibody identification.
Implications:
- Medical pathologists must be aware of daratumumab's potential to interfere with multiple myeloma diagnostics.
- Accurate interpretation of laboratory tests is crucial for assessing treatment response in patients receiving daratumumab.
- Understanding these interferences is vital for effective patient management and therapeutic decision-making in multiple myeloma.
Abstract:
We report the case of a 54 years old patient monitored for a monoclonal IgG kappa light chain refractory relapsed multiple myeloma and receiving daratumumab immunotherapy. Daratumumab (DARA), a monoclonal anti-CD38 antibody, belongs to the new generation of immunotherapy in refractory relapse multiple myeloma which the medical pathologist should be aware of to avoid misinterpretation of biological tests performed for patients followed for this disease. By its IgG1K humanized monoclonal antibody backbone, DARA interferes in both serum protein electrophoresis and immunofixation by the presence of an alternate IgGK monoclonal peak, leading to a possible difficulty to assess treatment's response in monoclonal IgG kappa light chain myeloma. By its intrinsic anti-CD38 activity DARA also interferes in the screening and identification of red blood cells alloantibodies, due to stabilized red cells reagent expressing weakly the CD38 molecule. We manage to overcome this last interference by using dithiotreitol.
