Elranatamab in Relapsed/Refractory Multiple Myeloma: A Multicenter Real-World Study from Türkiye
Aslı Bozdemir, Sibel Hacıoğlu, Gülsüm Akgün Çağlıyan, Nevin Alayvaz Aslan, Süleyman Utku Uzun, Kayıhan Kara, Utku Iltar, Orhan Kemal Yücel, Ünal Ataş, Selin Arslan Kirezli, Ali İhsan Gemici, İnci Alacacıoğlu, Mustafa Kemal Yeniay, Oktay Bilgir, Zehra Narlı Özdemir, Handan Haydaroğlu Şahin, Ayşe Uysal, Zekeriya Aksöz, Zeynep Tuğba Güven, Kemal Aygün, Atakan Tekinalp, Mehmet Yılmaz, Cansu Atmaca Mutlu, Gökhan Pektaş, Ozan Salim, Nil GülerBackground: Elranatamab, a bispecific antibody targeting BCMA and CD3, has demonstrated clinical activity in relapsed/refractory multiple myeloma. Real-world evidence regarding infectious complications and supportive care remains limited. We evaluated the early clinical activity, safety profile, infectious complications, and supportive care practices associated with relapsed/refractory multiple myeloma (RRMM). This study represents one of the first multicenter real-world evaluations of elranatamab in Türkiye. Methods: This multicenter retrospective study included 87 patients with relapsed/refractory multiple myeloma treated with elranatamab. Clinical characteristics, treatment responses, immune-mediated toxicities, infectious complications, and supportive care practices were assessed. Overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) were evaluated. Multivariable analyses were performed to identify factors associated with treatment response and clinical outcomes. Results: At 3 months, ORR was 47.1% in the ITT population, 54.7% in the mITT population, and 83.7% among evaluable patients; corresponding 6-month ORRs were 31.0%, 42.2%, and 81.8%, respectively. The high proportion of patients without landmark response assessments primarily reflected insufficient follow-up, early death, or disease progression. Elevated LDH remained independently associated with lower response probability and inferior clinical outcomes. Cytokine release syndrome (CRS) occurred in 69% of patients, with grade ≥ 3 events in 5.7%, whereas immune effector cell-associated neurotoxicity syndrome (ICANS) was infrequent (4.6%) and no grade ≥ 3 events occurred. Grade ≥ 3 infections occurred in 39% of patients, including CMV events requiring antiviral treatment in 24.1%. No HBV reactivation occurred among patients receiving antiviral prophylaxis. Median PFS and OS were 8.1 and 10.6 months, respectively. Conclusions: Elranatamab demonstrated early clinical activity and a manageable safety profile in a heavily pretreated real-world RRMM population. Infectious complications, including CMV events, remained clinically relevant, emphasizing the importance of supportive care. Longer follow-up is needed to characterize long-term outcomes.