Recurrent Anterior Uveitis Associated With Teclistamab in Relapsed/Refractory Multiple Myeloma
Teclistamab, a BCMAxCD3 bispecific antibody, has demonstrated significant efficacy in relapsed/refractory multiple myeloma (RRMM). The most commonly reported adverse events include cytokine release syndrome, infections, and cytopenias. Ocular inflammatory toxicities remain poorly characterized, with very limited data available in the literature.
Materials and Methods/Case Presentation/Objective:
We report the clinical course of an 80-year-old woman with heavily pretreated IgG lambda RRMM who developed recurrent anterior uveitis during teclistamab treatment. Clinical, ophthalmologic, and laboratory findings were retrospectively reviewed, including infectious and viral studies performed on blood samples and aqueous humor.
Results/Description/Main Outcome Measure(s):
The patient had previously received multiple treatment lines, including VTd, lenalidomide-dexamethasone, daratumumab-based therapy, and KPd, which was discontinued after ocular thrombotic complications. Ophthalmologic history was notable for left central retinal vein occlusion, neovascular glaucoma, hypertensive uveitis secondary to intravitreal aflibercept, and severe visual impairment in the left eye. No previous inflammatory involvement had been documented in the right eye before teclistamab exposure.
Due to biochemical progression and CAR-T refusal, fifth-line therapy with teclistamab was initiated. During treatment, the patient developed a first episode of acute anterior uveitis in the right eye, requiring temporary teclistamab interruption and treatment with topical and systemic corticosteroids, achieving clinical improvement. Following drug rechallenge, a second episode of anterior uveitis occurred, leading to definitive treatment discontinuation.
Ophthalmologic examination demonstrated preserved visual acuity in the right eye, positive anterior chamber Tyndall effect, absence of posterior synechiae, and no significant vitreous inflammation. Extensive diagnostic work-up excluded infectious causes and viral reactivation through serological testing and aqueous humor analysis. Symptoms resolved with oral prednisone taper, topical prednisolone, and atropine.
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