LP-09. Clinical case of multiple myeloma treated with IsaPD triplet after autologous HSCT
Оksana Е. Ochirova, Erzhena B. Zhalsanova, Alina G. Karpova, Anna N. Alexeeva, Elena Zh. Bykova, Irina S. Ulanova, Ailana V. Sodboeva, Tumen V. Dondokov
N. A. Semashko Clinical Republican Hospital, Clinical Hospital RZhD-Medicine, Ulan-Ude, Russia
Contact: Dr. Oksana E. Ochirova, e-mail: okso4irova@mail.ru
Summary
Rapid and aggressive course of multiple myeloma (MM) in resistant/refractory cases non-responding to proteasome inhibitors and immunomodulatory drugs require usage of target therapy by means of monoclonal antibodies. The aim of present work was to show efficiency of anti-CD38 Mab in a single clinical case of refractory/resistant MM following autologous HSCT (auto-HSCT).
Clinical case
A female patient 47 years old is observed with multiple myeloma (MM) since 2021 to the present time at the N. A. Semashko Clinical Republican Hospital, (Ulan-Ude). Currently, she has stage IIIA MM, diffuse-focal form with IgG paraprotein secretion of kappa chains, M gradient of 24.72 g/L. Protein fractions: gamma, 36.1%; beta 2-MG, 1.35 mg/L, cryoglobulin absent, total calcium, 2.28, plasma cells, 8%, relapsing/refractory clinical course. The disorder was complicated by compression vertebral fracture (ThVIII). The disease relapse was registered in 2021 following 3 rounds of VCD protocol, complicated by polyneuropathy, with M gradient of 0.79 g/L. Later on, the patient was subjected to the RD schedule (12 rounds) in February 2022, with M gradient fading away. However, the new relapse was documented as early as in June 2022 with M gradient reaching 1.5 g/L and 1% plasma cells. In October 2022, the patient underwent autologous HSCT at V. A. Almazov Federal Medical Research Center due to failed response to previous therapy. The IsaPd protocol has been chosen for subsequent treatment (Isatuximab, Pomalidomid, Dexamethason). The patient underwent 7 rounds of the IsaPd therapy associated with improvement of general condition, laboratory signs of remission confirmed by the blood tests (ESR, 16 mm/h; Hb, 137 g/L; platelets, 327; total protein, 67 g/L, creatinine, 76 mcmol/L, urea, 5.5 mmol/L, M gradient, 0.46 g/L, absence of plasma cells in bone marrow. CT scans show degenerative/atrophic changes of lumbar spine, osteochondrosis of the secondary discs, protrusions of the vertebral discs L3-L4, L4-L5, L5-S1, deforming spondilosis.
Conclusion
The results obtained suggest a rationale for IsaPd protocol usage after auto-HSCT in the patients refractory to proteasome inhibitors and lenalidomide.
Keywords
Multiple myeloma, refractory, IsaPD therapy, clinical case.
