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Corneal in vivo confocal microscopy to detect belantamab mafodotin-induced ocular toxicity early and adjust the dose accordingly: a case report
Journal of Hematology & Oncology ( IF 28.5 ) Pub Date : 2021-10-03 , DOI: 10.1186/s13045-021-01172-5
Kevin Marquant 1, 2 , Anne Quinquenel 1, 2 , Carl Arndt 1, 2 , Alexandre Denoyer 1, 2, 3, 4, 5
Affiliation  

New targeted antibody–drug conjugates (ADCs) against multiple myeloma are known to induce adverse effects that may lead to treatment discontinuation. Preclinical studies reported early severe ocular damage related to the use of belantamab mafodotin (belamaf), including ocular surface inflammation, severe dry eye, and a specific toxicity to the cornea, namely microcystic keratopathy. While belamaf-induced ocular changes have not been prospectively studied, a better understanding of mechanisms involved as well as kinetics may aid in anticipating dose adjustment rather than stopping the treatment once clinical ocular damage is too severe. A 61-year-old woman scheduled for belamaf as a fifth-line treatment against multiple myeloma was prospectively included. Clinical examinations were performed before and every 3 weeks afterward, together with in vivo confocal microscopy (IVCM) of the cornea. Visual acuity, symptoms, slit-lamp examination, and ultrastructural changes of the cornea were recorded according to the received dose of belamaf. More precisely, kinetics, shape, density, and location of the toxic corneal lesions have been followed and analyzed using IVCM. Also, specific lesions at the sub-basal nerve plexus layer were detected and characterized for the first time. This advanced approach allowed a better understanding of the belamaf-induced toxicity, further balancing the dose to maintain good vision and eye health while continuing the treatment. Systematic ultrastructural analysis and follow-up of the corneal state during ADCs treatment for multiple myeloma may open new avenues in the therapeutic approach. Early preclinical detection of ocular damage may accurately contribute to finding the correct dose for each patient and not stopping the treatment due to severe ocular adverse effects.

中文翻译:

角膜体内共聚焦显微镜早期检测belantamab mafodotin诱导的眼部毒性并相应调整剂量:病例报告

已知针对多发性骨髓瘤的新型靶向抗体 - 药物偶联物 (ADC) 会引起可能导致治疗中断的不良反应。临床前研究报告了与使用 belantamab mafodotin (belamaf) 相关的早期严重眼部损伤,包括眼表炎症、严重干眼症和对角膜的特定毒性,即微囊性角膜病变。虽然尚未对 belamaf 引起的眼部变化进行前瞻性研究,但更好地了解所涉及的机制和动力学可能有助于预期剂量调整,而不是一旦临床眼部损伤太严重就停止治疗。一名 61 岁的女性计划将 belamaf 作为针对多发性骨髓瘤的五线治疗方案被前瞻性纳入。之前和之后每 3 周进行一次临床检查,连同角膜的体内共聚焦显微镜(IVCM)。根据所接受的 belamaf 剂量记录视力、症状、裂隙灯检查和角膜超微结构变化。更准确地说,已经使用 IVCM 跟踪和分析了毒性角膜病变的动力学、形状、密度和位置。此外,首次检测并表征了亚基底神经丛层的特定病变。这种先进的方法可以更好地了解 belamaf 引起的毒性,进一步平衡剂量以在继续治疗的同时保持良好的视力和眼睛健康。ADCs 治疗多发性骨髓瘤期间角膜状态的系统超微结构分析和随访可能为治疗方法开辟新的途径。
更新日期:2021-10-04
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