• Adrian Duek, Emmanuel Lellouche, Sharon Ben Baruch, Reut Mashiach, Yafit Segman, Gabriel Bryk, and Merav Leiba.
• Department of Hematology, Samson Assuta Ashdod University Hospital, Ashdod, Israel, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
• Isr Med Assoc J. 2022 Oct 1; 24 (10): 629-633.

BackgroundMultiple myeloma (MM) accounts for approximately 10% of hematological malignancies. The monoclonal immunoglobulin G kappa (IgG-κ) daratumumab can bind to CD38 on MM cells and be detected in serum immunofixation (IF), causing pitfalls in M-protein quantification.ObjectivesTo determine the efficacy of mitigating the interference of IgG MM treated with daratumumab.MethodsLevels of Ig, free light chains (FLC) kappa (κ) and lambda (λ), serum protein electrophoresis (SPE)/IF, and Hydrashift 2/4 assays were assessed following manufacturer's instructions in three patients.ResultsPatient 1 was a 70-year-old male diagnosed with IgG-λ MM. The IF distinguished two monoclonal bands (IgG-κ and IgG-λ). With the Hydrashift assay, the daratumumab-anti-daratumumab immune complex shifted the IgG-κ to the α zone, suggesting that the monoclonal IgG-κ band corresponded to daratumumab. Patient 2 was a 63-year-old male with IgG-κ MM who was receiving daratumumab once every other week. SPE/IF assay revealed a faint monoclonal IgG-κ band in the  zone. A stronger monoclonal band was observed after administration. The IgG-κ band disappeared on the Hydrashift assay, while the daratumumab-anti-daratumumab complex appeared as a broad smear in the α-region. Patient 3, a 63-year-old male diagnosed with IgG-λMM, was receiving daratumumab once every other month. The IF assay showed two distinct bands (IgG-κ and IgG-λ) post-daratumumab administration. The shift to the α zone of the IgG-κ bands on the Hydrashift assay confirmed that the additional band observed post-infusion was due to the daratumumab.ConclusionsThe Hydrashift assay can help distinguish daratumumab from endogenous M-spike.

12 keywords...

hide…