Strategies for managing belantamab mafodotin-associated ocular toxicities

During the Multiple Myeloma Hub Steering Committee Meeting on May 12, 2026, key opinion leaders met to discuss strategies for managing belantamab mafodotin-associated ocular toxicities in patients with multiple myeloma (MM). The meeting featured a presentation by guest speaker Lisa Leypoldt, University Medical Center Hamburg-Eppendorf, followed by a faculty discussion on the practical challenges of monitoring, managing, and counseling patients receiving belantamab mafodotin-based therapies. 

During their presentation, Leypoldt reviewed the mechanisms underlying belantamab mafodotin-associated ocular toxicity, highlighting the role of off-target uptake into corneal epithelial cells and the resulting transient visual symptoms (Figure 1). Leypoldt discussed the clinical manifestations of ocular events, including keratopathy, changes in visual acuity, and patient-reported symptoms, before outlining evidence-based approaches to monitoring and management. Leypoldt also reviewed data from the DREAMM-7 (NCT04246047) and DREAMM-8 (NCT04484623) studies, evaluating the role of dose modifications and extended dosing intervals in managing ocular toxicity (Figure 2). The subsequent faculty discussion focused on multidisciplinary care, patient counseling, and practical considerations for integrating ocular toxicity monitoring into routine clinical practice. 

Key learnings 

• Belantamab mafodotin-associated ocular toxicity results from off-target uptake into corneal epithelial cells, leading to microcyst-like epithelial changes that may cause blurred vision and reduced visual acuity.¹ 
• Ocular events associated with belantamab mafodotin are generally reversible, with recovery occurring through regeneration of the corneal epithelium.^1,2 
• Assessment of ocular toxicity should incorporate ophthalmic examination, visual acuity testing, and patient-reported symptoms, including the impact of visual changes on daily activities.⁵ 
• Baseline ophthalmologic evaluation and ongoing monitoring during early treatment cycles are important components of toxicity management.⁵ 
• Early identification and reporting of visual symptoms can facilitate timely intervention and support continued treatment.⁵ 
• Management of ocular toxicity commonly involves dose delays, treatment interruptions, and extension of dosing intervals based on the severity of ocular findings.⁴ 
• Data from the DREAMM-7 and DREAMM-8 studies demonstrate that dose modifications were frequently required in clinical practice, with dose delays occurring in most patients.⁴ 
• Extended dosing intervals were associated with a reduction in ocular events over time and allowed recovery from treatment-related ocular toxicity. 
• Clinical responses were generally maintained despite extended dosing intervals. 
• Effective management of ocular toxicity requires collaboration between hematology, ophthalmology, and primary care teams, with clear communication regarding monitoring findings and treatment decisions. 
• Patient counseling should include discussion of expected visual symptoms, their potential impact on quality of life, the reversibility of ocular events, and the role of dose modifications in toxicity management.