Efficacy and safety of bispecific antibodies in multiple myeloma patients with end-stage renal disease undergoing hemodialysis: a case report of elranatamab and a literature review

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Recent advances in multiple myeloma (MM) treatment, including bispecific antibodies (BsAbs), have improved outcomes. Elranatamab, a BsAb targeting B-cell maturation antigen and CD3, has shown efficacy in relapsed/refractory MM (RRMM). However, its use in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) is not well documented, as clinical trials often exclude this population. We report a 72-year-old woman with RRMM and ESRD on HD who was successfully treated with elranatamab after multiple prior therapies. She achieved a stringent complete response with undetectable minimal residual disease. Adverse events included grade 1 cytokine release syndrome, mild hypotension, and acute cholangitis, all resolved with appropriate management. Our literature review suggests BsAbs can be effective and generally well-tolerated in RRMM patients with ESRD on HD, although infection risk warrants caution. This report highlights elranatamab as a promising option for this vulnerable population. While initial responses and safety appear favourable, further studies are required to establish long-term outcomes.

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