Corneal Findings Associated to Belantamab-Mafodotin (Belamaf) Use in a Series of Patients Examined Longitudinally by Means of Advanced Corneal Imaging

Abstract

Belantamab mafodotin (belamaf) is a novel antibody–drug conjugate developed for the treatment of patients with relapsed or refractory multiple myeloma (RRMM). Although the drug has demonstrated a good efficacy, corneal adverse events have been reported. In this prospective study, consecutive patients with RRMM who received belamaf infusions were included. The standard ophthalmological visit was implemented with anterior segment (AS)-optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM). Five patients (three males, two females; mean age 66 ± 6.0 years) with MMRR and unremarkable ocular findings at baseline who received belamaf infusion were included. After a median time of 28 days from the first infusion, four of them developed corneal alterations with transient vision reduction to a variable extent. In particular, corneal deposits of microcyst-like epithelial changes (MECs) were detected centrally in one patient and peripherally in three patients. AS-OCT scans showed a bilateral heterogeneous increase in signal intensity, together with hyper-reflective lesions confined within the epithelium in all cases, except for one case in which they also involved the stroma. Corneal maps showed a transient increase in epithelial thickness in the first phase that was followed by a diffuse decrease in the subsequent phase. IVCM scans showed MECs as hyper-reflective opacities located at the level of corneal epithelium, largely intracellular. Multimodal corneal imaging may implement the current clinical scale, helping us to detect corneal abnormalities in patients under belamaf therapy. This workup provides useful data for monitoring over time corneal findings and for optimizing systemic therapy.

Corneal epithelial changes in a patient treated with belantamab mafodotin

“…However, AS-OCT and IVCM can also provide valuable support for follow-up. [ 17 , 18 ] These changes typically start in the peripheral cornea and then migrate toward the center, affecting vision quality and quantity.…”

Corneal Epithelial Thickness Mapping: A Major Review

“…In a study by Matsumiya et al, increased corneal epithelial thickness following belamaf treatment was demonstrated using AS-OCT measurements. Another study by Mencuci et al demonstrated a transient increase in epithelial thickness in RRMM patients on belamaf followed by a subsequent diffuse decline [ 204 , 212 ].…”

“…Some studies with diferent designs have evaluated ETM changes after cataract surgery [133,[201][202][203], almost all reporting an increase in the central and midperipheral CET with a gradual decrease to baseline levels within a month [133,[201][202][203]. However, their reported back-to-baseline time points varied; some studies report a return to preoperative levels within 3-7 days [202,203], while some others report longer durations ranging from 5-15 days [201,204] to 4 weeks [133]. In addition, CET reduction to baseline levels can take longer in people with diabetes [202].…”

Ocular Surface Side Effects of Novel Anticancer Drugs

“…The FDA also authorized belantamab mafodotin, a combination of microtubule inhibitors and antibodies directed against B-cell maturation antigens for the treatment of refractory multiple myeloma. Patients using this medication were shown to potentially develop corneal epithelial alterations resembling microcysts, which needed dose adjustments, reduction, or stop [132][133][134]. Before starting belantamab mafodotin and before each subsequent dose, the FDA advises to have a complete ophthalmological examination [135].…”