The role of monoclonal antibodies in treatment of refractory multiple myeloma

Multiple myeloma (MM) is a B-cell malignant tumor; its morphological substrate – plasma cells – produces monoclonal immunoglobulin. Primarily, MM is diagnosed in elderly people and is characterized by a variety of clinical manifestations caused by plasma cells infiltration and organ damage. Despite successes in MM therapy, in the majority of cases recurrences of MM or refractory process are observed. In this case, the choice of antitumor drug is usually made depending on its tolerability, toxicity, and availability. Selection of correct treatment can be complicated by such frequent clinical manifestations of MM as osteolytic vertebral lesions leading to development of pathologic compression fractures which in some cases cause spinal cord compression and full immobility in the patients with MM.A clinical case of a 62-year-old female patient with refractory MM is presented. Pathologic compression fractures of the Th12 and L2 vertebral bodies with massive extraosseous component at the Th12 vertebra level posed a threat of spinal cord compression. At the 1st stage, percutaneous vertebroplasty was performed, then antitumor therapy with daratumumab without increased intercycle intervals which significantly increased patient’s quality of life.