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Marilyn T Nedumcheril,1,2 Robert A DeSimone,1 Sabrina E Racine-Brzostek,1 Ok Kyong Chaekal,1,3 Ljiljana V Vasovic1 1Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA; 2New York Blood Center Enterprises, New York, NY, USA; 3Department of Medicine/Division of Hematology-Oncology New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USACorrespondence: Ljiljana V VasovicDepartment of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 251, New York, NY, 10065, USATel +1 212 746 6106Fax +1 212 746 8435Email ljv9004@med.cornell.eduAbstract: Daratumumab, a monoclonal antibody therapeutic, is highly efficacious and widely used in all stages of multiple myeloma and amyloidosis and has promising activity in other hematologic disorders. Daratumumab interacts with red blood cells, interfering with pre-transfusion testing. This interference can lead to compromising transfusion safety, extensive blood bank work ups and delays in provision of compatible units. Several methods have been developed to negate daratumumab interference with indirect antiglobulin testing. They are based on i) standard blood bank techniques including dithiothreitol and enzymatic treatment of reagent cells, using reagent red blood cells negative for CD38, ii) blocking CD38 antigens on reagent or donor cells, iii) neutralization of anti-CD38 antibody in patient plasma prior to testing, and iv) extended antigen typing of patient red blood cells in conjunction with provision of phenotypically matched units for transfusion. Implementation of those methods by the blood bank should be a planned effort coordinated with the patient’s clinical team. Timely involvement of blood bank and transfusion services and educational efforts by both blood banks and clinical providers can improve the overall daratumumab safety profile in regard to blood transfusion.Keywords: immunohematology, CD38, drug neutralization, dithiothreitol, incompatible crossmatch, indirect antiglobulin testing

The combination of cord blood transplant with progenitor cells from partially HLA-matched adult donors (haplo-cord transplant) has been used over the past two decades. In Europe and the US the adult donor graft is CD34 selected and provides early hematopoiesis, but durable engraftment derives from the cord blood graft (CD34 selected haplo-cord). Neutrophil recovery is prompt and rates of acute and chronic GVHD are low. Recent Chinese studies combine cord blood grafts with T-replete haplo-identical grafts (unmodified haplo-cord). The haplo graft usually establishes dominance and UCB chimerism is rarely detected. Comparison studies suggest considerably decreased rates of relapse and improved outcomes, compared with either haplo-identical transplant or CBU transplant, particularly in patients with advanced leukemia. A recent prospective randomized study confirms this. Haplo-cord mitigates the engraftment delay of UCB transplant. The unique biology of UCB grafts results in low GVHD and improved GVL especially beneficial in high-risk disease. [ABSTRACT FROM AUTHOR]

The incidence of adenovirus viremia and the role of screening in preventing adenovirus disease in adult transplant recipients are not well defined. Between January 2017 and May 2020, 262 allogeneic transplants were performed using in vivo T-cell depletion. Adenovirus viremia was found in 59 patients for a cumulative incidence of 10% by one hundred days and 23% (95% CI 20–26%) by one year. There was a higher incidence of viremia associated with cord blood transplant (p =.04). No other patient, donor or transplant characteristics were identified that predicted for viremia. In 47 patients (80%), viremia remained well below 200,000 copies/mL and resolved. Twelve patients developed high level viremia. Treatment with antivirals and in some cases adoptive cell therapy, was often ineffective and only two survived. Low lymphocyte count at initial detection of adenovirus viremia was the best predictor of uncontrolled disease. [ABSTRACT FROM AUTHOR]

The authors comment on a study by M. Manna and colleagues which suggested the important role for high-dose therapy and autologous transplants in patients with high-risk follicular lymphoma. Topics include comparison of patients undergoing stem cell transplant early in the course of their disease to those who did not receive a transplant, risk of novel conventional chemotherapies and targeted treatments, and reason that quality of life may be favorably affected by autologous transplantation.