Patient Scenario: Management of Multiple Myeloma With Talquetamab Therapy
Dive into a compelling case study showcasing the effective use of talquetamab therapy in the management of relapsed multiple myeloma, discussing responses, side effects, and treatment outcomes.
Transcript:
Sagar Lonial, MD, FACP: This is a great discussion, and you set up a great transition to the next points we want to talk through, which are some of the upcoming data, both in terms of response and management of bispecifics. Cesar, you were going to start us off with a case here.
Cesar Rodriguez, MD: I want to share a case of a patient whom we saw in clinic earlier this year: a 59-year-old [woman] who presented when she first [received a diagnosis of] multiple myeloma, with radiating pain to both legs, back in 2018. And she had imaging studies by her local primary care [physician], and there [were] degenerative changes, just like anybody. I’m 45 [years old], and I’m having problems too, so everybody has aches and stuff. But it was a persistent pain. So they did MRI of the spine to further evaluate this pain, and they found that there was a lesion in T12, approximately 1.5 cm, which prompted the work-up that led to findings that she did have an M [monoclonal] spike.
She didn’t have anemia. Hemoglobin [level] was 12.9, calcium [level] was normal at 9.5, normal renal function. But she did have a paraprotein with an M spike of 0.3. And the serum free light chains [levels] were elevated. Her κ light chain [level] was 3600, λ [level] was 1.2. So they completed the staging of the LDH [lactate dehydrogenase] within normal range but at 2 microglobulin [level] of 1.42, albumin [level of] 4. So she underwent a full work-up with a bone marrow biopsy and a PET [positron emission tomography] scan. The bone marrow biopsy [result] showed that she had 30% plasma cells, clonal plasma cells, IgG κ.
So she was classified [with] stage I multiple myeloma. And she underwent conventional induction therapy with bortezomib/lenalidomide/dexamethasone [and] achieved a very durable response with that and was in remission. She did not receive a transplant. We did collect cells. Well, they collected cells. She was not at our institution at that time. And they collected the cells, we stored the cells, and then she stayed in remission for 3 years and then [experienced] relapse. And for relapse, she got salvage therapy with pomalidomide/daratumumab/dexamethasone. And then she [experienced] relapse again, got dexamethasone, and then got treated with a bispecific therapy. And she got talquetamab.
So we started her on talquetamab therapy. And her baseline serology at that time, M spike, was 0. On PET scan, she had 1 main lesion in the pelvis. And then her light chains, her κ light chain [level] was 441. So it wasn’t as high as it was at the time of diagnosis. We started her on talquetamab. And after 1 cycle, her light chain [level] went from 441 down to 21, so almost normalized. By the fourth cycle, serology had normalized. PET scan showed that lesion she had in the pelvis had cleared, but we had a little problem.
She was having some adverse effects that were seen with talquetamab, and that was mainly dysgeusia. She was complaining that she couldn’t taste anything. She tried to eat things, and it felt like a ball of cardboard that was so hard to swallow. We spaced out the therapy, and the symptoms improved. She developed COVID-19, and we had to pause the therapy for a month, and her taste did improve almost 90%. And then when we restarted the therapy, we started to notice again some changes in her taste. But she remained in remission despite the breaks, and she’s still right now in complete remission.
Transcript is AI generated and edited for readability.
