CASE REPORT article
Front. Oncol.
Sec. Hematologic Malignancies
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1630929
Case Report: Reactive T-cell Large Granular Lymphocytes in the Bone Marrow of a Patient with Relapsed/Refractory Multiple Myeloma Receiving Teclistamab
Provisionally accepted
- University of Florida, Gainesville, United States
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T-cell engager therapies for the management of relapsed/refractory (R/R) Multiple Myeloma (MM) may lead to neutropenia with or without associated infections, which can limit treatment and efficacy. We present a case of a patient with penta-class R/R MM who, while receiving teclistamab, developed persistent severe to moderate neutropenia with associated infections. A review of her bone marrow confirmed the eradication of the malignant plasma cells, but flow cytometry identified an increase in Tcell large granular lymphocytes (T-LGLs). Upon further analysis, T-LGLs were found to be reactive and non-clonal, ruling out secondary T-LGL leukemia. This case describes the evolving peripheral blood cell counts, bone marrow composition, and radiologic findings due to activation of the patient's immune system before, during, and after treatment with teclistamab. To our knowledge, this is the first reported potential association of T-LGL activation with teclistamab treatment.
Keywords: Multiple Myeloma, T-LGL, Teclistamab, bispecific antibodies (BsAbs), bone marrow microenvironment (BMME)
Received: 18 May 2025; Accepted: 14 Jul 2025.
Copyright: © 2025 Dean, Yang, Seifert and Wingard. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Erin A. Dean, University of Florida, Gainesville, United States
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