How to treat hepatic extra-medullary involvement of myeloma: a case report and review of literature.

Extramedullary hepatic involvement is particularly rare. Here, we summarize published reports of hepatic myeloma treatment achieving infrequent and short-lived responses. Approach to a newly diagnosed multiple myeloma patient who presented with diffuse intrahepatic infiltration and cholestasis under frontline quadruplet induction will be presented here to complement the review. Contrary to earlier reports, he achieved a rapid response in/outside or marrow with elranatamab monotherapy. Importantly, this response enabled subsequent high dose melphalan and autologous stem cell transplantation (ASCT), which, otherwise, would not have been feasible. Currently under the 11th month of elranatamab treatment, patient is still in measurable residual disease (MRD)(-) CR. To our knowledge there has been no cases or series achieving such deep and durable responses for hepatic EMD. Elranatamab can be an effective and safe drug for extensive cholestatic liver myeloma involvement. Our results are quite premature, necessitating additional reports confirming the efficacy and safety of anti-BCMA bispecifics.