Abstract
Purpose :
Belantamab mafodotin is a new treatment for adults with relapsing or remitting multiple myeloma (RRMM). There are few studies characterizing belantamab-induced corneal toxicity. Our goal is to characterize the ocular adverse effects and toxicities in an underserved minority patient population.
Methods :
This is a retrospective case series of 6 patients who were treated with belantamab for RRMM from August 2020 to November 2021. Eye examination findings and visual acuity were graded based on the Keratopathy Visual Acuity (KVA) scale by a single examiner at baseline and every 3 weeks for the duration of treatment.
Results :
The average age of patients was 58 years. Three were female, 3 identified as Hispanic, and 3 as African-American. No patients had evidence of preexisting keratopathy on baseline exam. All were started on artificial tear drops prior to belantamab therapy. Three patients reported ocular symptoms after starting belantamab, including blurry vision, photopsias, and ocular irritation. Five patients developed Grade 1 keratopathy at 38.6 days and after 2 doses on average. Of those, 3 progressed to Grade 2 keratopathy after 78 days and 3.7 doses. One patient progressed to Grade 3 keratopathy after 73 days and 3 doses. The most common finding on slit lamp exam after treatment was diffuse superficial punctate epitheliopathy (83%), bilateral in all cases except for one. Three patients developed bilateral peripheral microcystic keratopathy and one patient progressed to central involvement (Figure 1). Mean change from baseline logarithm of the minimum angle of resolution UCVA was -0.05 in those with Grade 1 keratopathy, -0.24 for Grade 2 keratopathy, and -0.32 for Grade 3 keratopathy. Four of the 6 patients required dose interruption due to ocular toxicity, after an average of 3.5 treatments. Response to withholding of treatment was not fully evaluated as patients were lost to follow up due to worsening of their disease.
Conclusions :
Ocular toxicity occurred in all but 1 patient after starting belantamab, and 4 patients required dose interruption due to ocular toxicity. Worsening keratopathy correlated with decrease in visual acuity. Corneal changes were not always accompanied by symptoms or changes in visual acuity. Given the high frequency and often asymptomatic nature of keratopathy, close monitoring of the cornea and changes in visual acuity is prudent.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.