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Elranatamab: BCMA-Targeted Bispecific Antibody for Relapsed/Refractory Multiple Myeloma

T-cell engager therapy for heavily pretreated multiple myeloma patients

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Hematoloji department. Book Appointment →

What is Elranatamab: BCMA-Targeted Bispecific Antibody for Relapsed/Refractory Multiple Myeloma?

Elranatamab is a humanized IgG2a bispecific antibody that simultaneously binds B-cell maturation antigen (BCMA) on myeloma cells and CD3 on T cells.

FDA-approved in 2023 for adults with relapsed/refractory multiple myeloma who have received at least four prior lines of therapy.

Subcutaneous administration with weekly dosing initially, then biweekly maintenance reduces logistical burden compared to infusions.

Step-up dosing schedule mitigates cytokine release syndrome (CRS) risk during the first cycle.

Belongs to the same therapeutic class as teclistamab and talquetamab, expanding the bispecific armamentarium.

Symptoms

Cytokine release syndrome (CRS): fever, hypotension, hypoxia within 24 to 72 hours of initial doses.
Immune effector cell-associated neurotoxicity syndrome (ICANS): confusion, headache, seizure (rare).
Cytopenias: neutropenia, anemia, thrombocytopenia requiring close monitoring.
Infections: bacterial, viral (CMV, HSV reactivation), and opportunistic pathogens due to hypogammaglobulinemia.
Injection site reactions: erythema, induration, mild pain at the subcutaneous site.

Risk Factors

Heavy prior treatment burden including proteasome inhibitors, IMiDs, and anti-CD38 antibodies.
High disease burden at baseline correlates with greater CRS risk.
Pre-existing hypogammaglobulinemia or recurrent infection history.
Renal impairment requiring dose adjustment considerations.
Concurrent corticosteroid or immunosuppressive medication use.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Fever above 38°C within 72 hours of dosing requires urgent evaluation for CRS.
  • Confusion, slurred speech, or new neurological symptoms suggesting ICANS.
  • Persistent fatigue, pallor, or unusual bleeding indicating cytopenia.
  • Recurrent or severe infections during therapy.
  • Severe injection site reactions or systemic hypersensitivity.

Treatment Methods

01
Step-up dosing: 12 mg, then 32 mg subcutaneously, followed by full 76 mg weekly dosing for 24 weeks.
02
Premedication with dexamethasone, acetaminophen, and diphenhydramine before step-up doses.
03
CRS management: tocilizumab for grade 2 or higher events, supportive care for grade 1.
04
Infection prophylaxis: PJP prophylaxis, antiviral coverage, IVIG for hypogammaglobulinemia.
05
After 24 weeks, transition to biweekly dosing in responders for maintenance.

Which Department to Visit?

You can visit our Hematoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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