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Characteristics of isatuximab-derived interference in serum protein electrophoresis and immunofixation, and an absence of sustained in vivo interference due to belantamab mafodotin and denosumab.
Jimenez, Adam; Scholl, Ashley Rose; Wang, Bangchen; Schilke, Michael; Carlsen, Eric D.
Afiliação
  • Jimenez A; Department of Pathology, Duke University Medical Center, Durham, NC, USA.
  • Scholl AR; Department of Pathology, Duke University Medical Center, Durham, NC, USA.
  • Wang B; Department of Pathology, Duke University Medical Center, Durham, NC, USA.
  • Schilke M; Department of Pharmacy, Duke University Medical Center, Durham, NC, USA.
  • Carlsen ED; Department of Pathology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA. Electronic address: eric.carlsen@duke.edu.
Clin Biochem ; 127-128: 110761, 2024 May.
Article em En | MEDLINE | ID: mdl-38565341
ABSTRACT

OBJECTIVES:

Some therapeutic monoclonal antibodies, like daratumumab and elotuzumab, produce interfering monoclonal bands on serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE). Whether other common therapeutic antibodies also produce interference has not been systematically evaluated. DESIGN AND

METHODS:

SPEP/IFE from patients receiving isatuximab (48 patients), belantamab mafodotin (BM; 41), and denosumab (41) were retrospectively reviewed for therapeutic antibody interference. Cases exhibiting isatuximab interference were quantified and the maximum duration of isatuximab effect was evaluated. To characterize band position, neat human serum was spiked with BM or denosumab at supratherapeutic concentrations. Band migration patterns were compared on SPEP and IFE, with band position expressed relative to other constant protein fractions.

RESULTS:

Isatuximab-induced IFE interference was common (81.3 % of evaluated patients) with a maximum observed duration of 8 weeks. 10.4 % of isatuximab patients had IgG kappa monoclonal gammopathies that co-migrated with the drug; this subset could benefit from HYDRASHIFT 2/4 isatuximab testing. 8.3 % of IFE cases were negative for an isatuximab band but showed large, endogenous M-spikes migrating elsewhere. All patients in this group expired within 1 year of this finding. We hypothesize that an inability to detect isatuximab in this setting corresponds to a large residual myeloma burden that reduces isatuximab serum concentration. This observation may serve as a negative prognostic factor. Spiking studies demonstrated that BM and denosumab produce interference in vitro, but sustained interference was not observed in >40 treated patients.

CONCLUSIONS:

Therapeutic antibody interference in patients receiving isatuximab is common, and can persist for at least 8 weeks after administration. >10 % of patients receiving isatuximab may benefit from HYDRASHIFT testing post-therapy. In contrast, BM and denosumab fail to produce sustained interference in treated patients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Anticorpos Monoclonais Humanizados / Denosumab / Mieloma Múltiplo Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Biochem Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Anticorpos Monoclonais Humanizados / Denosumab / Mieloma Múltiplo Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Biochem Ano de publicação: 2024 Tipo de documento: Article