Tolerability of Bispecific Antibodies in Relapse/Refractory Multiple Myeloma (RRMM) Patients with Severe Renal Insufficiency: Case Series

• Published in: Blood 2024-11, Vol.144 (Supplement 1), p.7046-7046
• Main Authors: Efebera, Yvonne A., William, Basem M., Tokarski, Rebecca, Catanzaro, Julie, Mensah, Rebecca, Scott, Gary, Gillespie, Cassandra, Young, Emilee, Caulfield, Melissa, Verfurth, Quinn, Ghebremedhin, Hermon, Griffin, Anna, Kichigin, Jessie, Smiley, Rebecca, Phillips, Audra, Feinberg, Dan, Thompson, Megan, Braskett, Sara, Renner, Allyson, Minner, Jennifer, Lipstraw, Alexandria, Bope, Rose, Brown, Mitchell, Burns, Julia, Bangura, Isha, Hubbard, Rhonda, Brady, Bridgitte, Minor, Stephanie, Trikha, Prashant, Magzoub, Greeballa, Royero, Melissa, James, Evan
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2024-206178

Multiple Myeloma (MM) is the 2nd most common hematologic malignancy in the United States. While MM is not curable, novel therapies have significantly increased time to progression, decreasing morbidity and mortality. Teclistamab (Tec) and Talquetamab (Tal), both bispecific antibodies, have been approved for relapsed-refractory Multiple Myeloma (RRMM) (New Engl J Med. 2022; 2232-2244.; New Engl J Med. 2022;495-505.), but patients with creatinine clearance (Crcl) < 40 mL/min were excluded. We present two patients with renal insufficiency who have had positive response to Tec and Tal without excessive toxicity. Patient 1: 67-year-old man with Kappa light chain MM, had progression of disease (POD) on his 7th line of therapy. Baseline CrCl was 31 ml/min (Cr 2.92 mg/dl, weight 196 lbs) without need for dialysis. He was started on step-up dosing of Tec June 30, 2023. Tec was given subcutaneously (SC) at usual prescribed dose: D1, 0.06 mg/kg; D4, 0.3 mg/kg; D7, 1.5 mg/kg. This was followed by standard weekly dosing at 1.5 mg/kg. After one year, frequency was reduced to every 2 weeks. Labs at time of progression: white cell count (WBC) 2.78 K/mcl, Hemoglobin (Hgb) 10.1 g/dL, platelets (Plt) 61 K/mcl, Calcium (Ca) 8.6 mg/dL, Albumin (Alb) 3.5 g/dl, 24 urine total protein (TP) 1,141 mg/day with 676.1 mg (59.2%) kappa light chain, Creatinine peaked at 5.10 mg/dL, serum Kappa light chain peaked at 3726 mg/L with Kappa/Lambda (K/L) ratio 240.10 (normal 0.26-1.65). Myeloma bone survey without new lytic lesions. Bone Marrow (BM) biopsy with