Drug class: Monoclonal antibody, SLAMF7 (CS1)–directed humanized IgG1.
- Mechanism of action:
- Binds SLAMF7 (Signaling Lymphocytic Activation Molecule F7), highly expressed on myeloma cells and NK cells.
- Direct effects: Activates NK cells and enhances antibody-dependent cellular cytotoxicity (ADCC) against myeloma cells.
- Unlike daratumumab/izatuximab, it does not directly kill plasma cells—it requires immune effector activity.
- Indications (FDA/EMA approved):
- In combination with lenalidomide + dexamethasone (Elo-Rd) for relapsed/refractory multiple myeloma (≥1 prior therapy).
- In combination with pomalidomide + dexamethasone (Elo-Pd) after ≥2 prior therapies (incl. lenalidomide + proteasome inhibitor).
- Administration:
- IV infusion (10 mg/kg days 1, 8, 15, 22 of cycle 1; then less frequently in subsequent cycles; or flat dose 20 mg/kg).
- Requires premedication: dexamethasone, H1/H2 antihistamines, acetaminophen.
- First infusion: ~3–4 hours; later infusions may be shorter if tolerated.
- Key adverse effects:
- Infusion-related reactions (most during first infusion, less frequent than CD38 antibodies).
- Fatigue, diarrhea, constipation, cough.
- Infections: Pneumonia, herpes zoster reactivation (prophylaxis often recommended).
- Hematologic: Lymphopenia, neutropenia, anemia.
- Pharmacist notes:
- Does not interfere with serum protein electrophoresis (SPEP/IFE) unlike CD38 antibodies.
- Often used in combination with IMiDs (lenalidomide or pomalidomide) and dexamethasone.
- Monitor CBC, infection risk, infusion reaction.
Exam-relevant highlights:
- Target: SLAMF7 (not CD38).
- Requires combination therapy—ineffective as monotherapy.
- Key risks: infusion reactions, infections, lymphopenia.
- Unlike daratumumab/izatuximab, no SPEP interference.