Belantamab-Mafodotin Related Corneal Changes: An Ultrastructural Analysis

To characterize ultrastructural corneal changes in patient treated with Belantamab Mafodotin (Belamaf), a first-in-class anti-B-cell maturation antigen (BCMA) antibody–drug conjugate (ADC) for refractory multiple myeloma (RRMM).

This is a single-center case series of 4 patients with RRMM receiving intravenous (2,5 mg/kg) dose of Belamaf every three weeks and evaluated at Ophthalmology Center of Careggi Hospital, Florence

All 4 patients underwent screening ophthalmic examination before the enrollment and one week before every Belamaf administration for about 6 months. Ocular follow-up examinations included best corrected visual acuity (BCVA), slit lamp examination and pictures, near-infrared images of the cornea, corneal fluorescein staining, fundoscopy, intraocular pressure (IOP). Corneal ultrastructural features were analyzed using topography, Anterior Segment Optical Coherence Tomography (AS-OCT) and in Vivo Confocal Microscopy (IVCM).

The majority of patients showed central and peripheral corneal deposits, microcystic-like epithelial changes (MECS) arranged in a whorl-like pattern. Various degrees of keratopathy, with different visual impairment were identified. Corneal changes have been accurately detected and characterized in:  variation of corneal and epithelial thickness by epithelial mapping, depth of extension of corneal involvement by AS-OCT and ultrastructural changes in stromal nervous component by IVCM. In our small cases, no patients discontinued the treatment and only a delay of 1/2 weeks interval between doses has been suggested.

The administration of Belamaf induces a cumulative significant corneal toxic effect with visual disturbances that requires, in some cases, a delayed dose of therapy. Active collaboration with ophthalmologists is primary to promptly identify corneal/MECS and ultrastructural changes and to help hematologists in the management of Belamaf.