Belantamab Mafodotin Associated Keratopathy - Case Report

Belantamab mafodotin represents an innovative treatment for refractory or relapsing multiple myeloma. Despite encouraging clinical outcomes, the emergence of ocular toxicity raises significant concerns, necessitating dose adjustments or discontinuation. This report outlines the clinical manifestations and management of Belantamab mafodotin-related keratopathy.

The study was conducted at the Ophthalmology Department of Leicester University Hospitals - United Kingdom.

A 74-year-old male underwent ocular assessment before receiving an intravenous infusion of Belantamab mafodotin for refractory multiple myeloma. Initial evaluation showed uncorrected visual acuity of 0.1 LogMAR in the right eye and 0.2 LogMAR in the left eye, with an unremarkable ocular examination. Subsequently, the patient received the first dose of Belantamab mafodotin. The patient was advised to use sodium hyaluronate 0.2% four times daily for both eyes before and after the treatment.

Biweekly reviews post-infusion revealed that, on week two, the patient experienced increased blurriness and dry eye like symptoms. Assessments demonstrated a significant decline in visual acuity to uncorrected vision of 0.5 LogMAR in the right eye and 0.64 LogMAR in the left eye. Ocular examination revealed bilateral superficial punctate microcystic epithelial deposits grade 1 in the right eye and grade 2 in the left eye. In liaison with the hematology oncologist, the decision was made to postpone the second dose due to evidence of ocular toxicity. Two weeks later, the there were slight improvment of micocystic epitheliopathy with development of subepithelial haze more in the left eye. The patient is still under follow up.

Belantamab mafodotin-related keratopathy presents a significant dose-dependent adverse event that may result in vision deterioration in multiple myeloma patients receiving this emerging treatment. Timely recognition, along with appropriate dose spacing and adjustments, is crucial for minimizing the risk of corneal toxicity and visual loss.