Interdisciplinary management of belantamab mafodotin-associated ocular toxicity in clinical practice

IF 6.6 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface Pub Date : 2025-10-01 DOI:10.1016/j.jtos.2025.09.003

Mattan Arazi , Aya Wattad , Hila Magen , Abraham Avigdor , Nirit Agay , Yoav Berger , Irina S. Barequet

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引用次数: 0

Abstract

Purpose

Belantamab mafodotin (BLENREP), an antibody–drug conjugate for relapsed/refractory multiple myeloma (RRMM), is associated with corneal toxicity driven by limbal stem cell dysfunction and corneal epithelial damage. We examined how keratopathy severity relates to hematologic management decisions in clinical practice.

Methods

Retrospective cohort at a tertiary referral center, including RRMM patients treated with belantamab mafodotin (2019–2022). Ophthalmic examinations were performed at baseline and before each cycle; keratopathy was graded using the Keratopathy and Visual Acuity (KVA) scale. The primary outcome was the association between KVA severity (modeled as a time-dependent covariate) and management (dose reduction, treatment holiday, or discontinuation). Secondary outcomes included predictors of severe KVA, impact of management on immediate KVA change, and timing of the first management change.

Results

Among 41 patients (mean age 67.10 ± 11.78 years; 23/41 [56.1 %] female), 38/41 (92.68 %) developed KVA keratopathy. The median time to first KVA occurrence was 4.14 weeks, and to first management change was 7.29 weeks. Higher KVA grade was associated with earlier management change (HR 1.514; 95 % CI 1.048–2.187; p = 0.0270). At the first assessment after the initial intervention, KVA worsened after treatment holidays (+0.70 ± 0.114 grades) and improved after dose reductions (−0.20 ± 0.084; p = 0.0165). Overall, during follow-up, the most common intervention was a treatment holiday (23/37, 56.1 %), followed by dose reduction (16/37, 39.0 %) and discontinuation (6/37, 16.2 %).

Conclusion

KVA keratopathy occurred more frequently than in clinical trials, and nearly all patients required treatment modification. Given the strong relationship between KVA severity and management decisions, close ophthalmic monitoring from Grade 1 is warranted to mitigate progression and reduce vision-related morbidity.

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贝兰他单-马夫多汀相关眼毒性的跨学科管理。

目的：Belantamab mafodotin （BLENREP）是一种用于复发/难治性多发性骨髓瘤（RRMM）的抗体-药物偶联物，与角膜缘干细胞功能障碍和角膜上皮损伤驱动的角膜毒性相关。我们研究了在临床实践中角膜病变严重程度与血液学管理决策的关系。方法：在三级转诊中心进行回顾性队列研究，包括接受贝兰他单-马福多汀治疗的RRMM患者（2019-2022）。在基线和每个周期前进行眼科检查；使用角膜病变和视力（KVA）量表对角膜病变进行分级。主要结局是KVA严重程度（建模为时间相关协变量）与治疗（剂量减少、治疗期或停药）之间的关联。次要结局包括严重KVA的预测指标、管理对即刻KVA变化的影响以及首次管理变更的时间。结果：41例患者中（平均年龄67.10±11.78岁，女性23/41(56.1%)），38/41（92.68%）发生KVA性角膜病变。到第一次KVA发生的中位时间为4.14周，到第一次管理层变更的中位时间为7.29周。较高的KVA等级与较早的管理变更相关（HR 1.514; 95% CI 1.048-2.187; p=0.0270）。在初始干预后的第一次评估中，KVA在治疗假期后恶化（+0.70±0.114级），在剂量减少后改善（-0.20±0.084;p=0.0165）。总体而言，在随访期间，最常见的干预措施是治疗假期（23/ 37,56.1%），其次是减少剂量（16/ 37,39.0%）和停药（6/ 37,16.2%）。结论：KVA角膜病变的发生率高于临床试验，几乎所有患者都需要修改治疗方案。鉴于KVA严重程度与治疗决策之间的密切关系，从1级开始密切的眼科监测是有必要的，以减缓进展和减少视力相关的发病率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ocular Surface 医学-眼科学

CiteScore

11.60

自引率

14.10%

发文量

审稿时长

39 days

期刊介绍： The Ocular Surface, a quarterly, a peer-reviewed journal, is an authoritative resource that integrates and interprets major findings in diverse fields related to the ocular surface, including ophthalmology, optometry, genetics, molecular biology, pharmacology, immunology, infectious disease, and epidemiology. Its critical review articles cover the most current knowledge on medical and surgical management of ocular surface pathology, new understandings of ocular surface physiology, the meaning of recent discoveries on how the ocular surface responds to injury and disease, and updates on drug and device development. The journal also publishes select original research reports and articles describing cutting-edge techniques and technology in the field. Benefits to authors We also provide many author benefits, such as free PDFs, a liberal copyright policy, special discounts on Elsevier publications and much more. Please click here for more information on our author services. Please see our Guide for Authors for information on article submission. If you require any further information or help, please visit our Support Center