At ASH 2023, Hamza Hashmi, MD, a medical doctor and hematologist from Charleston, South Carolina, discussed a multicenter study focusing on the toxicity and efficacy outcomes associated with Teclistamab in patients above the age of 70 with relapsed refractory multiple myeloma.
The retrospective analysis included nearly 100 patients, with around one-third of them aged 70 or above. Dr. Hashmi highlighted the challenges faced by older patients, such as compromised physical performance status, organ dysfunction, renal issues, and other high-risk disease features. Over a median follow-up of approximately three and a half months, the study revealed comparable safety and efficacy outcomes between patients above and below the age of 70. Despite a higher incidence of grade 3 and 4 thrombocytopenia in the older cohort, no significant variations were observed in other toxicities associated with Teclistamab.
When discussing the implications of these findings on treatment decisions for older patients, Dr. Hashmi emphasized that age should not be a deterrent for considering T-cell engager therapy, given the similar responses and progression-free survival observed across age groups.
Dr. Hashmi also delved into the significance of the higher incidence of grade 3 and 4 thrombocytopenia in older patients, attributing it to factors such as longer-standing myeloma diagnoses, increased prior lines of therapy, and diminished bone marrow reserve. He underscored the need for careful monitoring and intervention, such as utilizing medications like romax, to manage thrombocytopenia effectively.
The discussion extended to the safety profile of Teclistamab in older patients regarding infection rates. Despite the vulnerability of older individuals to infections, Dr. Hashmi highlighted the effectiveness of anti-infective prophylaxis, including acyclovir, Bactrim, and IVIG, in mitigating infection risks associated with Teclistamab therapy.
In conclusion, Dr. Hamza Hashmi’s comprehensive insights provided a detailed examination of Teclistamab therapy in older patients with relapsed refractory multiple myeloma, with a focus on objective data and clinical considerations.