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Monitoring, prophylaxis, and treatment of infections in patients with MM receiving bispecific antibody therapy: consensus recommendations from an expert panel
Open accessAbstract
Bispecific antibodies (BsAbs) are emerging as an important novel class of immunotherapeutic agents for the treatment of multiple myeloma (MM), and are set to be more widely used in clinical practice. However, this new class of therapies is associated with a distinct adverse event (AE) profile that includes cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, as well as AEs leading to increased infection risk such as cytopenias and hypogammaglobulinemia, and infections themselves. As preliminary data with this class of agents shows an increased risk of infections as compared with conventional MM treatment regimens, such as immunomodulatory drugs, proteasome inhibitors, and anti-CD38 monoclonal antibodies (mAbs), guidance on infection monitoring, prophylaxis and treatment is required. This review provides consensus recommendations from a panel of 13 global experts, following a meeting in August 2022. The meeting objective was to review existing literature and identify relevant information on infections with all BsAbs in patients with MM, as well as to discuss clinical experience of experts in managing these infections. The recommendations outlined here can be used to guide management of infection risk factors, such as hypogammaglobulinemia and neutropenia. In addition, they can be used to guide the monitoring, prophylaxis, and treatment of bacterial, viral and fungal infections, including emerging infections of interest, such as coronavirus 2019 (COVID-19), and the use of vaccinations prior to and during BsAb treatment. The recommendations have been graded by the panel based on level of data available. Key recommendations include universal herpes simplex and varicella zoster virus prophylaxis, screening for hepatitis B virus reactivation risk in all patients, monthly intravenous immunoglobulin treatment for immunoparesis and in the absence of life-threatening infectious manifestations, use of colony-stimulating factors in patients with Grade 3 neutropenia, universal pneumocystis jirovecii pneumonia prophylaxis and no routine anti-fungal prophylaxis.
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“Results further emphasize the importance of early infection prevention in patients receiving bispecific antibodies, including use of immunoglobulin replacement per IMWG guidelines to reduce high-grade infections.36–40”
From Teclistamab plus Daratumumab in Relapsed or Refractory Multiple Myeloma (2026) · cites this paper as [36]
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Elranatamab in relapsed or refractory multiple myeloma: phase 2 MagnetisMM-3 trial results
Lesokhin, A. M., Tomasson, M. H., Arnulf, B., Bahlis, N. J., Miles Prince, H., Niesvizky, R., Rodrίguez-Otero, P., Martinez-Lopez, J., Koehne, G., Touzeau, C., et al. (2023) · Nature Medicine · doi:10.1038/s41591-023-02528-9 · Cited by 664
Self-citationLinvoseltamab for Treatment of Relapsed/Refractory Multiple Myeloma
Bumma, N., Richter, J. R., Jagannath, S., Lee, H. C., Hoffman, J. E., Suvannasankha, A., Zonder, J. A., Shah, M. R., Lentzsch, S., Baz, R., et al. (2024) · Journal of Clinical Oncology · doi:10.1200/jco.24.01008 · Cited by 191
Dimopoulos, M., Terpos, E., Boccadoro, M., Moreau, P., Mateos, M., Zweegman, S., Cook, G., Engelhardt, M., Delforge, M., Hájek, R., et al. (2025) · Nature Reviews Clinical Oncology · doi:10.1038/s41571-025-01041-x · Cited by 188
Self-citationRodríguez‐Otero, P., Usmani, S. Z., Cohen, A. D., van de Donk, N. W. C. J., Leleu, X. P., Pérez‐Larraya, J. G., Manier, S., Nooka, A. K., Mateos, M., Einsele, H., et al. (2024) · The Lancet Oncology · doi:10.1016/s1470-2045(24)00043-3 · Cited by 157
Self-citationTalquetamab plus Teclistamab in Relapsed or Refractory Multiple Myeloma
Cohen, Y. C., Magen, H., Gatt, M. E., Sébag, M., Kım, K., Min, C., Ocio, E. M., Yoon, S.-S., Chu, M. P., Rodríguez‐Otero, P., et al. (2025) · New England Journal of Medicine · doi:10.1056/nejmoa2406536 · Cited by 118
Self-citation
Metadata
- Authors
- Raje, N., Anderson, K., Einsele, H., Efebera, Y., Gay, F., Hammond, S. P., Lesokhin, A. M., Lonial, S., Ludwig, H., Moreau, P., Patel, K., Ramasamy, K., & Mateos, M.-V.
- Affiliations
- Harvard University (US)
- Dana-Farber Cancer Institute (US)
- Universitätsklinikum Würzburg (DE)
- OhioHealth (US)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- Massachusetts General Hospital (US)
- Memorial Sloan Kettering Cancer Center (US)
- Emory University (US)
- Wilhelminen Hospital (AT)
- Centre Hospitalier Universitaire de Nantes (FR)
- The University of Texas MD Anderson Cancer Center (US)
- University of Oxford (GB)
- Corresponding author
- Raje, Noopur
- ORCID
- Venue
- Blood Cancer Journal
- Published
- 2023-08-01
- Volume
- 13
- Issue
- 1
- Pages
- 116-116
- ISSN
- 2044-5385 (ISSN-L)
- PMC
- PMC10394080
- OpenAlex
- W4385456897
- Cited by
- 209
- References
- 72
- Citations by year
- 2026: 81 · 2025: 64 · 2024: 54 · 2023: 10
- FWCI
- 43.17
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Blood Cancer Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Pfizer
- Topics
- Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Life Sciences › Immunology and Microbiology › Immunology › Monoclonal and Polyclonal Antibodies Research
- Keywords
- multiple myeloma, bispecific antibodies, infection risk, infection control, infection treatment, hypogammaglobulinemia, neutropenia, COVID-19 pandemic, HBV reactivation, intravenous immunoglobulin, colony-stimulating factors, Pneumocystis carinii pneumonia prophylaxis, antifungal prophylaxis, viral and bacterial infections
- MeSH terms
- COVID-19, Agammaglobulinemia, Humans, Multiple Myeloma, Neutropenia, Antibodies, Bispecific, Neurotoxicity Syndromes, Consensus
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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