June 2024: Isatuximab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma
The issue
Adding the anti‑CD38 antibody isatuximab to the standard bortezomib + lenalidomide + dexamethasone (VRd) regimen kept newly diagnosed, transplant‑ineligible multiple‑myeloma patients in remission far longer than VRd alone. After five years, 63 % of people on the four‑drug combination were still free of disease progression versus 45 % on VRd (hazard ratio 0.60).
What do I need to know?
The phase‑3 IMROZ trial followed 446 adults aged 55–80. Three‑quarters of those given isatuximab‑VRd achieved a complete response, and over half became minimal‑residual‑disease (MRD) negative—both markedly better than standard VRd. Serious side‑effects were similar between groups; grade‑3 or worse infections occurred in 45 % on isatuximab‑VRd versus 38 % on VRd, and no new safety issues emerged. Quality‑of‑life scores stayed stable during the prolonged treatment.
Potential risk of myeloma progression
Stable disease on first‑line VRd, no high‑risk cytogenetics.
Recommended Actions
Check blood counts, renal function, and M‑protein every 1–3 months.
Ask the hematologist whether adding isatuximab now could deepen remission.
Keep up antiviral/antibiotic prophylaxis, vaccines, and bone‑strengthening therapy.
Imminent risk of progression
Only a partial response or an early biochemical rise in M‑protein.
Recommended Actions
Discuss switching to, or intensifying with, isatuximab‑VRd at the next cycle.
Repeat bone‑marrow and MRD testing for a clearer picture of residual disease.
Review infection‑prevention steps and dose‑adjust drugs for kidney function.
Confirmed progression
Rising M‑protein with symptoms (anemia, bone pain, renal decline).
Recommended Actions
Start isatuximab‑VRd (or another CD38‑based regimen) promptly.
Consider referral to a myeloma center or clinical trial.
Monitor closely for neutropenia, neuropathy, and infections; add growth‑factor support if needed.
