Thread by @Abdallah81MD

Teclistamab in RRMM with Renal Impairment Real-world data from the USMIRC multi-institutional study 🧵

1️⃣🧬 (n=195) shows that teclistamab remains safe and effective even in patients with significant renal dysfunction (CrCl <40 mL/min) — a population excluded from the original MAJESTEC-1 trial.
#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

2️⃣ Mechanism Refresher 🔬
Teclistamab = BCMA × CD3 bispecific antibody

➡️ Targets BCMA on myeloma cells
➡️ Engages CD3 on T cells
➡️ Activates cytotoxic response (perforin + granzymes)

Result: T-cell–mediated myeloma cell killing.

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

3️⃣ Study Design 📊
Multi-institutional USMIRC real-world analysis

• 195 RRMM patients
• 17% with renal impairment (CrCl <40 mL/min)
• Median age ~70
• Similar disease characteristics across groups
• Standard step-up dosing → 1.5 mg/kg weekly

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

4️⃣ Efficacy Results 🎯
Renal dysfunction did NOT compromise efficacy

• PFS: No difference between RI vs non-RI
• HR 0.92 (p = 0.9)
• ~50% PFS at ~8 months in both groups

👉 Overall response strongly correlated with longer PFS (p <0.001)

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

5️⃣ Safety Profile ⚠️
Toxicities were similar regardless of renal function

CRS: 43.8% vs 52.5%
ICANS: 14.6% vs 10.6%
Any infection: 44% vs 46%

➡️ No statistically significant differences.

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

6️⃣ Important Clinical Signal 🩸
Patients with renal impairment required more supportive care:

🩸 pRBC transfusion:
50% vs 24% (p = 0.003)

Likely due to baseline cytopenias and marrow reserve, not drug toxicity.

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

7️⃣ CRS Management Insight 🧠
Interestingly:

💊 Less dexamethasone required for CRS in RI patients
(12% vs 28%)

Median CRS onset ≈ 4.5 days.

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

8️⃣ Predictors of Shorter PFS 📉
Independent risk factors included:

• Poor performance status
• 1q gain
• Higher prior lines of therapy
• Lenalidomide / carfilzomib refractory disease
• Recent BCMA exposure
• Extramedullary disease

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

9️⃣ Clinical Implication 🏥
This analysis suggests:

🚫 Renal dysfunction should NOT exclude patients from teclistamab therapy

Even patients with severe renal impairment or dialysis may benefit.

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

@USMIRCNEWS @US_HMC @OncoAlert mdpi.com/2072-6694/18/5…