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225Ac-anti-idiotype sdAb is a preclinical, personalized targeted alpha-particle radionuclide therapy (TRNT) being investigated for the treatment of multiple myeloma. It consists of a llama-derived single-domain antibody fragment (sdAb) radiolabeled with the alpha-emitter Actinium-225 (225Ac). The sdAb is engineered to target the patient-specific idiotype of the membrane-bound paraprotein expressed on malignant plasma cells. This approach is inherently personalized, requiring the generation of a unique sdAb for each patient by immunizing llamas with paraprotein extracted from the patient's serum. Preclinical studies in mouse models of minimal residual disease (MRD) have demonstrated high tumor selectivity and potent antitumor activity with minimal off-target toxicity.
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