Elranatamab for Treatment of Multiple Myeloma With Central Nervous Involvement Refractory to Other Interventions

Background Plasma cell leukemia and central nervous system involvement are two poor prognostic factors in myeloma, and such patients are often excluded from clinical trials. Case A 59‐year‐old patient with primary plasma cell leukemia developed leptomeningeal CNS disease following autologous transplant. Intrathecal chemotherapy and selinexor, pomalidomide, and dexamethasone failed to clear cerebrospinal fluid plasma cells. Intervention Elranatamab achieved complete serological and CNS response. The patient recovered from bedbound status to full independence and proceeded to receive CAR‐T therapy. At 8 months post CAR‐T, he remains in sustained MRD negativity. Conclusion Sequential bispecific antibody and CAR‐T therapy demonstrates exceptional efficacy in CNS multiple myeloma, offering new hope for this historically terminal condition and supporting the systematic study of novel immunotherapies in high‐risk myeloma populations. Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.