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Primary concerns include increased injection site reactions from multiple subcutaneous injections, difficulty attributing adverse effects to the correct agent, additional cost without proven benefit, and potential quality variability in compounded lipotropic products

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27,28 Metanalyses and systematic reviews have yielded inconsistent results, and although their effectiveness remains inconclusive, these infusions have been adopted into clinical practice anyway

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While the reaction of the therapeutic antibody seems relatively straightforward on the myeloma side (as MM cells are FcR-negative), more complex interactions occur with effector cells (FcR + ), where the antibody can engage both the Fab-binding site and one of the FcRs on the same cell ( Figure 3 ) (110)