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<p>Relapsed/refractory multiple myeloma (RRMM) with extramedullary disease (EMD) is associated with poor prognosis and limited response to standard therapies. Elranatamab, a bispecific antibody targeting BCMA and CD3, has demonstrated clinical activity in triple-class-exposed (TCE) RRMM but remains less effective in patients with EMD. We report a case of a 67-year-old woman with TCE RRMM and aggressive EMD that progressed after two cycles of elranatamab. Following the addition of Juzentaihoto (JTT), a traditional Japanese herbal medicine, rapid symptom improvement, tumor regression, and disappearance of M-protein on immunofixation were observed. Moreover, after JTT initiation, lymphocyte and CD4–CD8bright cell counts increased rapidly and robustly, suggesting that JTT may enhance the elranatamab-induced antitumor immune response via these cells. To our knowledge, this is the first in vivo report indicating that JTT increases CD4–CD8bright lymphocyte counts in humans. JTT may enhance the efficacy of T cell–redirecting immunotherapies in RRMM by promoting cytotoxic T cell expansion. These findings warrant further investigation into the use of JTT as an adjunct to improve outcomes in patients with EMD.</p>

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Synergistic effects of elranatamab and Juzentaihoto, Japanese traditional herbal medicine, in triple-class-exposed relapsed/refractory multiple myeloma with extramedullary disease: a case report

  • 期刊论文

  • 发表日期：

    2026年2月2日

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  • Naohi Sahara,
  • Takashi Matsunaga,
  • Go Chie,
  • Mai Mizusawa,
  • Yukiko Miura,
  • Seiichiro Kobayashi,
  • Tomoki Fujii,
  • Nobuhiro Ohno

摘要

Relapsed/refractory multiple myeloma (RRMM) with extramedullary disease (EMD) is associated with poor prognosis and limited response to standard therapies. Elranatamab, a bispecific antibody targeting BCMA and CD3, has demonstrated clinical activity in triple-class-exposed (TCE) RRMM but remains less effective in patients with EMD. We report a case of a 67-year-old woman with TCE RRMM and aggressive EMD that progressed after two cycles of elranatamab. Following the addition of Juzentaihoto (JTT), a traditional Japanese herbal medicine, rapid symptom improvement, tumor regression, and disappearance of M-protein on immunofixation were observed. Moreover, after JTT initiation, lymphocyte and CD4–CD8bright cell counts increased rapidly and robustly, suggesting that JTT may enhance the elranatamab-induced antitumor immune response via these cells. To our knowledge, this is the first in vivo report indicating that JTT increases CD4–CD8bright lymphocyte counts in humans. JTT may enhance the efficacy of T cell–redirecting immunotherapies in RRMM by promoting cytotoxic T cell expansion. These findings warrant further investigation into the use of JTT as an adjunct to improve outcomes in patients with EMD.