Alopecia Areata: Hair and Nail Findings in a Patient Undergoing Talquetamab Therapy for Multiple Myeloma

Main Article Content

Victoria Jiminez
Andrew Fortugno
Ayodele Adelanwa
Carly Elston
Boni Elewski

Keywords

alopecia areata, nail, talquetamab, multiple myeloma

Abstract

Redirecting T cell-mediated killing of GPRC5D-expressing myeloma cells, talquetamab is a novel chemotherapeutic humanized bispecific antibody increasingly used for treatment of relapsed or refractory multiple myeloma. While skin-related adverse events, including nail disorders, were common in the initial clinical trials, hair pathology was not reported. We present a case of a 74-year-old female undergoing talquetamab therapy presenting with a one-year history of alopecic patches in addition to nail changes, glossitis, and keratoderma. Scalp punch biopsy revealed alopecia areata later found to be responsive to betamethasone dipropionate gel. This case highlights a spectrum of adverse cutaneous manifestations of talquetamab therapy likely secondary cross reactivity to GPRC5D-expressing keratinized structures. Deeper investigation is warranted to clarify the pathogenesis underlying these findings and optimal treatment modalities for this patient cohort undergoing talquetamab therapy.

References

1. Chari A, Minnema MC, Berdeja JG, et al. Talquetamab, a T-Cell-Redirecting GPRC5D Bispecific Antibody for Multiple Myeloma. N Engl J Med. 2022;387(24):2232-2244. doi:10.1056/NEJMoa2204591

2. Narayan N, Williams B, Lipe B, Benedetto AD. Onychomadesis and palmoplantar keratoderma associated with talquetamab therapy for relapsed and refractory multiple myeloma. JAAD Case Rep. 2023;31:66-68. doi:10.1016/j.jdcr.2022.11.013

3. Berdeja JG, Krishnan AY, Oriol A, et al. Updated results of a phase 1, first-in-human study of talquetamab, a G protein-coupled receptor family C group 5 member D (GPRC5D) × CD3 bispecific antibody, in relapsed/refractory multiple myeloma (MM). J Clin Oncol. 2021;39(15_suppl):8008-8008. doi:10.1200/JCO.2021.39.15_suppl.8008

4. Inoue S, Nambu T, Shimomura T. The RAIG family member, GPRC5D, is associated with hard-keratinized structures. J Invest Dermatol. 2004;122(3):565-573. doi:10.1046/j.0022-202X.2004.12628.x

5. Mailankody S, Devlin SM, Landa J, et al. GPRC5D-Targeted CAR T Cells for Myeloma. N Engl J Med. 2022;387(13):1196-1206. doi:10.1056/NEJMoa2209900

6. Ferreira SB, Scheinberg M, Steiner D, Steiner T, Bedin GL, Ferreira RB. Remarkable Improvement of Nail Changes in Alopecia Areata Universalis with 10 Months of Treatment with Tofacitinib: A Case Report. Case Rep Dermatol. 2016;8(3):262-266. doi:10.1159/000450848

7. Chelidze K, Lipner SR. Nail changes in alopecia areata: an update and review. Int J Dermatol. 2018;57(7):776-783. doi:10.1111/ijd.13866

8. Azzawi S, Penzi LR, Senna MM. Immune Privilege Collapse and Alopecia Development: Is Stress a Factor. Skin Appendage Disord. 2018;4(4):236-244. doi:10.1159/000485080

Most read articles by the same author(s)

1 2 3 > >>