Corneal Changes With Antibody-Drug Conjugate in Myeloma: Mechanism Remains Unknown
Posted: Wednesday, January 27, 2021
In a single-center case series following 12 patients with refractory multiple myeloma who were being treated with the antibody-drug conjugate belantamab mafodotin-blmf, results showed that all were affected by progressive corneal microcyst-like epithelial changes, which have been described previously in the literature. The changes appeared at first in the peripheral cornea and then progressed centrally with time, described Wuqaas M. Munir, MD, of the University of Maryland School of Medicine, Baltimore, and colleagues in the journal Eye & Contact Lens.
When therapy was interrupted, the changes regressed first in the peripheral cornea and then centrally, the team described. However, the same type of changes recurred in each patient who was retreated.
What’s more, “with prolonged therapy, eight patients developed corneal staining patterns suggestive of limbal stem cell dysfunction,” noted Dr. Munir and colleagues. So, they added, “further study [should] determine the etiology and composition of the microcyst-like epithelial changes and the mechanism of limbal stem cell involvement…. [Currently], we postulate that the changes are either composed of anomalous epithelial cells or deposited drug products. [But] the mechanism by which [these changes] associated with belantamab mafodotin find their way into the anterior cornea remains unknown.”
Some patients taking belantamab mafodotin are well aware of this adverse effect. Of the 12 patients in the study, 4 developed blurred vision and 1 had eye pain. The corneal changes developed an average of 34 days after the first treatment dose, and those receiving a higher dose (3.4 mg/kg) developed such ocular side effects more quickly (in a mean of 21 days) than those receiving a lower dose (2.5 mg/kg; mean, 38 days). Therapy interruption or cessation, and not merely lowering the infusion dose, resulted in full resolution of the keratopathy.
Disclosure: The study authors’ disclosure information can be found at journals.lww.com.