Real-World Infection Picture With Bispecific Antibody Therapy for Multiple Myeloma

By: Celeste L. Dixon
Posted: Friday, April 28, 2023

Researchers performed a retrospective review of 39 patients with multiple myeloma who received bispecific antibody therapy over more than 4 years in one institution’s clinical trials to learn about the epidemiology and outcomes of the patients’ infections. The results should help “better guide [future] antimicrobial prophylaxis and treatment in this emerging cohort…to minimize the burden of infection,” explained Beatrice Z. Sim, MBBS, of Peter MacCallum Cancer Centre, Parkville, Victoria, Australia, and colleagues in Blood Cancer Journal.

Of the 39 patients, 4 had no infection and 35 had at least one infection, for a total of 111 infections—microbiologically defined, clinically defined, or fever of unknown focus. A total of 16 patients had at least one grade 3 or higher infection; 63 infections in 30 patients resulted in hospital admissions and prolonged antibiotic use. All patients received a median of five cycles of bispecific antibody therapy and a median of six prior lines of therapy.

Further studies are required to optimize prophylactic and preventive strategies, stressed the investigators, but this study is reportedly the first to fully characterize infections in this type of patient group. For these 39 patients, the investigators’ findings included the following:

The respiratory and gastrointestinal systems were the most common sites of infection, in 46 and 8 infections, respectively.
Of the microbiologically defined infections, 58% were viral; the most common were rhinovirus or enterovirus, followed by cytomegalovirus and adenovirus.
The patients received a diverse range of antifungal prophylaxis strategies, and no episodes of invasive fungal disease occurred.
Most incidents of fever of unknown focus were likely attributable to cytokine-release syndrome, which was documented in 28 patients.
The median cumulative prednisone-equivalent dose received by patients in the 30 days prior to infection was 266.7 mg. At Peter MacCallum, valaciclovir and trimethoprim/sulfamethoxazole are routinely used for herpes simplex, zoster, and pneumocystis prophylaxis, respectively, and antibacterial prophylaxis is not routinely used.

Disclosure: The study authors’ disclosure information can be found at nature.com.

Blood Cancer Journal