Page 356 - Haematologica Vol. 109 - July 2024

CASE REPORT
Figure 2. Timeline comparing positron emission tomography scans from April 2023 and August 8, 2023. Scan show interval im- provement in left proximal thigh mass and left subcutaneous nodularity, alongside treatment dates.
flare in skin lesions provides a biochemical timeline not documented previously. In these other cases, patients were also managed symptomatically and monitored with resolution of TFR at 6 weeks. As such awareness of the timing and nature of the phenomenon appears to be key to preventing adverse outcomes.
While poorly understood, the phenomenon of TFR has been linked to an immune response and T-cell infiltration leading to inflammation and disease activity.7 This is important to consider for EMD patients as they have traditionally been considered to have a higher risk disease and a lower re- sponse rate to the BiTE. Given the intrinsic immunomod- ulatory and T-cell engaging nature of BiTE, TFR may prove to be a greater adverse event in BITE therapies than prior therapies and will remain an ongoing challenge to differ- entiate from a true progression. It is for these reasons that improving the identification, management, and the decision of therapy continuation in patients with TFR is a matter of clinical importance. Importantly, both talquetamab and teclistamab were safely given to this patient with end-stage renal disease on hemodialysis, a patient population that was excluded in the pivotal clinical trials.
Finally, our case shows that patients resistant to one T-cell redirecting therapy may respond to a second agent with a different target. The effectiveness of talquetamab in this teclistamab-refractory patient provides further data for BiTE sequencing.
As further immunotherapies are introduced for myeloma patients, the development of guidelines for BiTE sequencing, and TFR monitoring will be beneficial to develop a uniform
approach for the management of patients with EMD that are treated with BiTE.
Authors
Mark Forsberg,1 Santiago Beltran,2 Mendel Goldfinger,1 Murali Janakiram,3 Deepak Kalbi,4 Amit Verma,1 Dennis Cooper1 and Nishi Shah1
1Department of Oncology, Montefiore Medical Center, New York, NY; 2Division of Internal Medicine, Montefiore Medical Center-Wakefield Campus, New Yor, NY; 3Department of Hematology and Hematopoietic Cell Transplantation, Cit of Hope Cancer Center, Duarte, CA and 4Department of Radiology, Montefiore Medical Center, New Yor, NY, USA
Correspondence:
N. SHAH - nisshah@montefiore.org
https://doi.org/10.3324/haematol.2023.284436
Received: October 20, 2023. Accepted: February 13, 2024. Early view: February 22, 2024.
©2024 Ferrata Storti Foundation Published under a CC BY-NC license
Disclosures
No conflicts of interest to disclose.
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