Schweighofer Jakob, Agis Hermine, Krauth Maria, Donner Ruth, Funk Marion, Lammer Jan, Klimek Michal, Schmidinger Gerald, Aschauer Julia
Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
Clinical Division of Hematology and Hemostaseology (H.A.), Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Ophthalmol Ther. 2025 May 6. doi: 10.1007/s40123-025-01147-6.
This prospective case series investigated corneal epithelial and subbasal nerve plexus changes associated with belantamab mafodotin (Belamaf) therapy in patients with refractory/relapsed multiple myeloma using a multimodal imaging approach.
We included eight patients (mean age 66 ± 10) scheduled for Belamaf who were monitored for at least three treatment cycles. Standard clinical eye exams with Snellen best corrected visual acuity (BCVA) measurements were complemented by epithelial thickness mapping, slit lamp photography, corneal sensitivity testing, and corneal confocal microscopy.
The mean drop in BCVA was limited to 1 line (20/25 to 20/32) with mean loss in sensitivity from 5.2 ± 0.4 to 8.7 ± 3.4 mg/S. Corneal epithelial thickness increased (from a mean of 62 ± 4.7 to 74 ± 6.2 μm) presenting an irregular pattern from the apex to the mid-periphery. All patients developed microcystic epithelial changes and ocular surface disease. Confocal microscopy revealed a decrease in mean nerve fiber length and density from 12.46 ± 4.94 mm/mm and 21.87 ± 10.27/mm at baseline to 3.27 ± 3.9 mm/mm and 1.78 ± 3.22/mm at last follow-up, respectively, with preserved limbal architecture.
This prospective study confirms and further characterizes the pathognomonic epithelial changes caused by Belamaf, which are accompanied by severe impairment in subbasal nerve fiber architecture, indicating a neurotoxic effect of the medication that requires further investigation.
本前瞻性病例系列研究采用多模态成像方法，调查了难治性/复发性多发性骨髓瘤患者接受贝兰他单抗马福多汀（Belamaf）治疗时角膜上皮和基底膜下神经丛的变化。
我们纳入了8例计划接受Belamaf治疗的患者（平均年龄66±10岁），对其进行了至少三个治疗周期的监测。标准临床眼科检查包括Snellen最佳矫正视力（BCVA）测量，并辅以角膜上皮厚度测绘、裂隙灯照相、角膜敏感性测试和角膜共焦显微镜检查。
BCVA平均下降限于1行（从20/25降至20/32），敏感性平均从5.2±0.4降至8.7±3.4mg/S。角膜上皮厚度增加（从平均62±4.7μm增至74±6.2μm），从角膜顶点到中周边呈现不规则模式。所有患者均出现微囊性上皮改变和眼表疾病。共焦显微镜检查显示，平均神经纤维长度和密度从基线时的12.46±4.94mm/mm和21.87±10.27/mm分别降至末次随访时的3.27±3.9mm/mm和1.78±3.22/mm，角膜缘结构保持完整。
这项前瞻性研究证实并进一步描述了由Belamaf引起的特征性上皮改变，同时伴有基底膜下神经纤维结构的严重受损，表明该药物具有神经毒性作用，需要进一步研究。
