Daratumumab 투여를 받은 다발성 골수종 환자에서 비예기항체 동정검사상 범응집 소견을 보인 1예 = A Case of Panagglutination on Antibody Identification in a Multiple Myeloma Patient Receiving Daratumumab

다국어 초록 (Multilingual Abstract)

Herein, we report a patient showing panagglutination in the unexpected antibody identification test after the administration of daratumumab. The patient was a 66-year-old woman who had undergone multiple cycles of chemotherapy and autologous peripheral blood stem cell transplantation for treating multiple myeloma; however, despite treatment, she had relapsed. Therefore, daratumumab, on clinical trials in Korea, started to be administered.
After administration of daratumumab, the result of antibody screening test was positive, on the contrary to the result prior to the administration. Moreover, all positive reactions were shown in the antibody identification to the panel cells. After destroying CD38 antigens on the surface of RBCs using DTT, negative results were obtained.
Daratumumab—a novel therapeutic human CD38 monoclonal antibody that can be used as targeted immunotherapy—is an FDA-approved drug for treating multiple myeloma. Because CD38 is expressed not only on myeloma cells, but also on red blood cells (RBCs), the use of daratumumab might lead to RBC agglutinations, and thereby resulting in false-positive results on the pre-transfusion tests. Therefore, caution is needed in case of a patient receiving daratumumab. Furthermore, additional test using DTT is required, especially when panagglutination was shown in the antibody identification test, as in this case.

국문 초록 (Abstract)

저자들은 daratumumab 투여 후 비예기항체 동정검사상 범응집 소견을 보인 증례를 경험하였기에 보고하는 바이다. 환자는 66세 여성으로 다발성골수종 치료를 위해 항암화학요법과 자가조혈모세포이식 등을 시행하였으나 재발 소견을 보였다. 이에 국내에서 임상시험 중인 daratumumab을투여하기 시작하였다. Daratumumab 투여 전에는비예기항체 선별검사상 음성이었으나 투여 후에는 양성이었고, 비예기항체 동정검사상 범응집소견을 보였다. 이에 DTT를 처리하여 적혈구 표면의 CD38 항원을 파괴시킨 후 재검한 결과 음성으로 전환되었다. Daratumumab은 다발성골수종치료에 있어서 미국 FDA로부터 최초로 승인을받은 anti-CD38 단클론항체로서 골수종 세포에대한 표적치료가 가능하다. 그러나 CD38은 골수종 세포 뿐만이 아니라 적혈구에도 발현될 수 있기 때문에 수혈전검사에서 위양성 결과를 초래할수 있다. 따라서 다발성골수종 환자에서 daratumumab을투여하는 경우에는 수혈전검사 결과 해석에 주의를 해야 하며, 특히 비예기항체 동정검사상 범응집 소견을 보이는 경우에는 DTT 처리를 하여 추가적인 검사를 시행해야 할 것이다.

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