Isatuximab-containing regimens for the treatment of patients with newly diagnosed multiple myeloma: A literature review and a clinical case

Multiple myeloma (MM) is a malignant clonal lymphoproliferative disease. Over the past few decades, there has been a breakthrough in the treatment of MM due to the introduction of high-dose therapies and innovative biological agents. Currently, approaches to therapy of both candidates and non-candidates for autologous hematopoietic stem cell transplantation (auto-HSCT) are still evolving. Isatuximab is an immunoglobulin (Ig)Gk monoclonal antibody to CD38 that has anti-tumor activity through several mechanisms of action. The effectiveness of adding isatuximab to three-component regimens in patients with MM was studied in several randomized studies. Publications on the use of isatuximab-containing MM induction therapy regimens were reviewed. The authors’ experience of using the Isa-VRd regimen in a patient with MM who is not a candidate for auto-HSCT is presented. The patient, 72 years old, was admitted to the National Medical Research Center for Hematology in September 2024 with suspected paraproteinemic hemoblastosis. The disease onset was acute; azotemia signs appeared in August 2024. A full range of laboratory and instrumental examinations diagnosed symptomatic MM with acute renal injury. Due to the advanced age and comorbidities, the patient was not considered a candidate for high-dose chemotherapy with auto-HSCT. The patient was initiated with four-component therapy according to the Isa-VRd regimen. After the first course, a very good partial remission and a partial renal response were achieved. Treatment continued; currently, the patient is receiving the third course.