IVIg Use Associated with Ten-Fold Reduction of Serious Infections in Multiple Myeloma Patients Treated with Anti-BCMA Bispecific Antibodies
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Abstract
BCMA-targeted bispecific antibodies (BiAb) are efficacious in relapsed/refractory multiple myeloma; however, serious infections have emerged as important toxicities. In this retrospective study, we characterized all infections and their risk factors, and evaluated the impact of infection prophylaxis in patients treated with BCMA-targeted BiAbs. Among 37 patients, 15 (41%) experienced a grade 3–5 infection, with two infection-related deaths during deep remissions. Most (84%) infections occurred during disease remissions. The cumulative probability of grade 3–5 infection increased over time with no plateau. Among responders (n = 26), profound hypogammaglobulinemia occurred in 100% and continued throughout the entire duration of treatment. During periods when patients were receiving intravenous immunoglobulin (IVIg), the rate of grade 3–5 infections was 90% lower than during observation (incidence rate ratio, 0.10; 95% confidence interval, 0.01–0.80; P = 0.0307). No other risk factors for infection were identified. This study demonstrates that profound hypogammaglobulinemia is universal with BCMA-targeted BiAbs, with intravenous immunoglobulin potentially abrogating most of the infection risk. Significance: To the best of our knowledge, this is the first study to comprehensively analyze risk factors and mitigation strategies to prevent infections in myeloma patients receiving anti-BCMA bispecific antibodies. Profound and prolonged hypogammaglobulinemia was universal among responders, while immunoglobulin replacement was associated with 90% lower rates of grade 3–5 infections. See related commentary by Garfall and Stadtmauer, p. 427 . This article is featured in Selected Articles from This Issue, p. 419
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Early infection prevention, including immunoglobulin replacement per IMWG guidelines, reduces high-grade infections in patients receiving bispecific antibodies.
“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 [38]
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- Authors
- Lancman, G., Parsa, K., Kotlarz, K., Avery, L., Lurie, A., Lieberman-Cribbin, A., Cho, H. J., Parekh, S. S., Richard, S., Richter, J., Rodriguez, C., Rossi, A., Sanchez, L. J., Thibaud, S., Jagannath, S., & Chari, A.
- Affiliations
- Princess Margaret Cancer Centre (CA)
- Icahn School of Medicine at Mount Sinai (US)
- Wrocław University of Environmental and Life Sciences (PL)
- University Health Network (CA)
- Tisch Cancer Institute (US)
- University of California, San Francisco (US)
- Corresponding author
- Lancman, Guido
- ORCID
- Venue
- Blood Cancer Discovery
- Published
- 2023-09-28
- Volume
- 4
- Issue
- 6
- Pages
- 440-451
- ISSN
- 2643-3230 (ISSN-L)
- 2643-3249
- PMC
- PMC10618720
- OpenAlex
- W4387128075
- Cited by
- 140
- References
- 43
- Citations by year
- 2026: 50 · 2025: 49 · 2024: 35 · 2023: 6
- FWCI
- 28.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Blood Cancer Discovery (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Polish National Agency for Academic Exchange (Preludium BIS 1 (2019/35/O/NZ9/00237))
- Topics
- Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Monoclonal and Polyclonal Antibodies Research
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Keywords
- intravenous immunoglobulin, multiple myeloma, serious infections, hypogammaglobulinemia, infection control, infection risk factors, relapsed/refractory multiple myeloma, immunoglobulin replacement therapy
- MeSH terms
- Agammaglobulinemia, Humans, Multiple Myeloma, Retrospective Studies, Immunoglobulins, Intravenous, Antibodies, Bispecific, B-Cell Maturation Antigen
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