Dr Mouhieddine on Ferritin and ALC As Markers of Bispecific Antibody Response in Myeloma

“Ferritin is a nonspecific inflammatory marker. To us, what matters is how much inflammation and immunosuppression there is in the bone marrow, which [we know from other studies can] affect clinical outcomes.”

Tarek Mouhieddine, MD, a medical oncologist at Dana-Farber Cancer Institute and an instructor in medicine at Harvard Medical School, discusses the potential utility of ferritin and absolute lymphocyte count (ALC) as biomarkers of response to bispecific antibodies for the treatment of patients with relapsed/refractory multiple myeloma.

Ferritin is a nonspecific inflammatory marker, Mouhieddine began. It can be used to gauge inflammation and immunosuppression in the bone marrow, which can affect clinical outcomes, he continued. This information could be useful in terms of predicting a response to bispecific antibodies in patients with relapsed/refractory multiple myeloma, he noted.

Regarding ALC, prior studies have shown that higher levels of lymphocytes present in the blood of a patient with relapsed/refractory multiple myeloma are correlated with heightened efficacy of bispecific antibodies, Mouhieddine explained. This concept is rooted in effector-to-target ratio, which quantifies the amount of T cells that are available to control disease, he added. Even if a higher dose of a bispecific antibody is administered, if a patient does not have the adequate number of T cells present, they will be unlikely to achieve good disease control, he noted. To a certain extent, ALC could be used to quantify the potential of bispecific antibodies to be effective for patients with multiple myeloma, he concluded.

During the 22nd Annual International Myeloma Society Meeting and Exposition, Mouhieddine presented findings from a retrospective single-center study of 325 patients with relapsed/refractory multiple myeloma who received bispecific antibody therapy. The goal of the study was to evaluate the utility of ferritin and ALC levels as predictive biomarkers for efficacy in patients who received bispecific antibodies. The study found that elevated ferritin levels and low ALC are correlated with worse outcomes in this population.