Isatuximab in Patients With Monoclonal Gammopathy of Renal Significance

Inclusion Criteria:

1. Renal biopsy proven diagnosis of an MGRS disorder including the following:

2. Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID)

3. C3 glomerulopathy associated with monoclonal gammopathy

4. Non-Amyloid Fibrillary Glomerulonephritis

5. Light chain Proximal Tubulopathy

6. Immunotactoid Glomerulopathy A concurrent diagnosis of Monoclonal gammopathy (with +ve Serum and/or Urine proteinelectrophoresis or Bone marrow biopsy) is required in patients with C3glomerulopathy but not for other disorders. Patients with concurrent MGUS, non-highrisk smoldering myeloma are eligible for enrollment.

7. Measurable Proteinuria ≥1gram over 24 hours.

8. Prior Therapy: Newly diagnosed as well as patients with previous therapy butpersistent renal dysfunction and persistent proteinuria ≥1gram over 24 hours areeligible for enrollment. Patients who received a prior cluster of differentiation 38 (CD38) antibody therapy are not eligible for study. In patients who have receivedprior therapy a wash out period of 12 weeks for chemotherapy based therapies and 24weeks for Rituximab based therapies is required between completion of prior therapyand cycle 1 Day1 of study therapy.

9. Age ≥18 years.

10. Eastern Cooperative Oncology Group (ECOG) performance status ≤2.

11. Life expectancy of greater than 6 months

12. Participants must have normal organ and marrow function as defined below:

Leukocytes ≥3,000/microliters (mcL)

1. absolute neutrophil count ≥1,500/mcL

2. platelets ≥100,000/mcL

3. total bilirubin within normal institutional limits

4. Aspartate aminotransferase (AST) (SGOT)/alanine transaminase (ALT)(SGPT) ≤2.5 ×institutional upper limit of normal

5. Estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2.

Exclusion Criteria:

1. Participants who have had chemotherapy based therapy within 12 weeks or Rituximabbased therapy within prior 24 weeks prior to starting the cycle 1 Day 1 of trialtherapy

2. Participants who are receiving any other investigational agents concurrently.

3. History of severe allergic reactions or anaphylaxis attributed to compounds ofsimilar chemical or biologic composition to Isatuximab.

4. Diagnosis of Multiple Myeloma or High risk smoldering Multiple Myeloma or a B celllymphoma meeting criteria for therapy.

5. Renal Biopsy showing the coexistence of other significant diagnosis e.g. diabeticnephropathy.

6. Uncontrolled intercurrent illness including, but not limited to, ongoing or activeinfection, symptomatic congestive heart failure, unstable angina pectoris, cardiacarrhythmia, or psychiatric illness/social situations that would limit compliancewith study requirements.

7. Pregnant and Lactating women are excluded from this study because there is anunknown but potential risk for adverse events in nursing infants secondary totreatment of the mother with Isatuximab.

8. HIV-positive Participants are ineligible because of increased risk of lethalinfections when treated with immunosuppressive therapy.