Current monoclonal antibody therapies for multiple myeloma have had limited success, perhaps due to narrow target specificity. We have previously described the ability of polyclonal rabbit antithymo-cyte globulin (rATG) to induce caspase-and cathepsin-mediated apoptosis in human B and plasma cells. We now extend this observation to myeloma cells. Complement independent cell death was measured after addition of rATG (1-1000 g/mL) to cultures of myeloma cell lines or primary CD138 isolates from patient bone marrow aspirates. rATG induced significant levels of apoptosis in my-eloma cells as assayed by caspase induction , annexin V binding, subdiploid DNA fragmentation, plasma-membrane per-meability, and loss of mitochondrial-membrane potential. Addition of complement greatly augmented myeloma-cell death. Binding of rATG to individual my-eloma cell-surface proteins, primarily CD38, CD52, CD126, and CD138, was demonstrated by competitive inhibition experiments with targeted monoclonal antibod-ies. Three pathways of cell death were identified involving caspase activation, cathepsin D, and the genistein sensitive tyrosine kinase pathway. F(ab) 2 fragments of rATG had reduced proapoptotic activity, which was restored by coincuba-tion with Fc fragments, and anti-CD32 or anti-CD64 antibodies. We conclude that rATG is an effective agent for in vitro induction of apoptosis in multiple myeloma, and that exploratory clinical trials may be warranted. (Blood. 2006;107:2895-2903)