Identifying and Managing Infections in BCMA Therapy in Multiple Myeloma

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Article
ONCOLOGY® CompanionONCOLOGY® Companion, Volume 37, Supplement 8
Volume 37
Issue 8
Pages: 19

Experts in the field of multiple myeloma highlight key takeaways for clinicans to be aware of for infections associated with bispecific antibody multiple myeloma treatments.

CancerNetwork® hosted a Training Academy focused on monitoring and managing infections in patients with multiple myeloma who are treated with bispecific antibodies.

Meet the experts

Meet the experts

Incidence of Infections

  • In clinical trials utilizing B-cell maturation antigen (BCMA) CD3 bispecific antibodies, infection rates were significantly higher across the board compared with patients who did not receive BCMA therapy.
  • Non-BCMA bispecific antibodies are associated with less-severe infections, due to the GPRC5D targets.
  • The longer patients remain on BCMA-targeted therapy, the higher the infection rate.

Monitoring Infections

  • When patients experience neutropenia during treatment, granulocyte colony stimulating factor (filgrastim) can be used to mitigate adverse effects.
  • If patients are receiving teclistamab-cqyv (Tecvayli) and have a neutrophil count of less than 0.5 × 109 L, the package insert recommends withholding dosing until neutrophil recovery.

Managing Infections

  • Intravenous immunoglobulin (IVIG) can be given to help treat infections in patients receiving BCMA therapies.
  • An increase in IVIG can cause a decrease in renal function, an increase in creatinine related to IVIG, and higher immunoglobulin levels.
  • Using low-sucrose IVIG can help minimize any renal dysfunction.

Key Takeaways

  • Patients with multiple myeloma on BCMA bispecific antibodies have an increased risk for infection. If such a patient is admitted to the emergency department and they have no COVID-19 antibodies, the staff must be informed about how to treat them.
  • Treatment with monoclonal antibodies can induce rapid and deep responses because they have a half-life of at least 1 week; this allows treatment withholding to be easier when infections occur.
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