Teclistamab in relapsed, multi-refractory acquired hemophilia A after failure of anti-CD19 CAR-T cell therapy

A patient with relapsed acquired hemophilia A (AHA), who previously failed multiple lines of immunosuppressive therapy (IST) including autologous anti-CD19 chimeric antigen receptor (CAR) T cell therapy received teclistamab, a bispecific monoclonal antibody engaging autologous CD3-positive T cells with the B cell maturation antigen (BCMA) on plasma cells and mature B cells. Teclistamab was well tolerated without clinically significant adverse events, except for hypogammaglobulinemia. Prompt and durable remission was observed that lasted for more than one year post treatment. This is the first case of refractory AHA successfully treated with teclistamab, providing a proof-of-concept of plasma cell-directed bispecific antibodies, supporting its further evaluation.