Belantamab mafodotin associated corneal microcyst-like epithelial changes

PURPOSE: To report a case of bilateral corneal microcyst-like epithelial changes associated with belantamab mafodotin (belamaf) therapy. OBSERVATIONS: A 70-year-old man with refractory multiple myeloma was placed on belamaf, a recently FDA-approved treatment for relapsed or refractory multiple myeloma. He developed decreased visual acuity and bilateral corneal microcyst-like peripheral epithelial changes. Belamaf was withheld. Anterior segment OCT showed intra-epithelial opacities at various depths. After resolution of corneal changes and recovery of vision, belamaf was restarted. The patient underwent two additional treatments, each time with recurrence of diffuse microcyst-like corneal epithelial changes. It took a total of 8, 11.5 and 17 weeks after each respective infusion for the microcyst-like epithelial changes to resolve. This suggested a longer recovery time after each subsequent infusion. CONCLUSIONS AND IMPORTANCE: The care for patients on belamaf requires the collaboration of eye care providers and hematologists-oncologists to assess for ocular adverse effects and adjust treatment as necessary. Further study is needed to illustrate the mechanism of corneal microcyst-like epithelial changes and its effects on limbal stem cells.