Risk of infections associated with the use of bispecific antibodies in multiple myeloma: a pooled analysis.

Abstract

The use of bispecific antibodies (BsAbs) in the treatment of relapsed/refractory multiple myeloma (MM) is showing early promising overall response rates in heavily pretreated patients. Infectious complications related to the use of BsAbs are not well described. We conducted a pooled analysis that included all single-agent BsAbs used in MM with no prior use of different BsAbs. A total of 1185 patients with MM were treated with a BsAb in the studied period (71.6% of the patients treated with an agent targeting B-cell maturation antigen (BCMA). Pooled median follow-up was short at 6.1months (7.5 vs 5.2months for BCMA vs non-BCMA BsAbs, respectively). Adverse events of interest included all grade neutropenia in 38.6%, all grade infections in 50% (n= 542/1083), all grade cytokine release syndrome in 59.6% (n= 706/1185), grade III/IV neutropenia in 34.8% (n= 372/1068), grade III/IV infections in 24.5% (n= 272/1110), grade III/IV pneumonia in 10% (n= 52.4/506), and grade III/IV coronavirus disease 2019 in 11.4% (n= 45.4/395) of the patients. Non-BCMA-targeted BsAbs were associated with lower grade III/IV neutropenia (25.3% vs 39.2%) and lower grade III/IV infections (11.9% vs 30%) when compared with BCMA-targeted BsAbs. Hypogammaglobulinemia was reported in 4 studies, with a prevalence of 75.3% (n= 256/340) of the patients, with IV immunoglobulin used in 48% (n= 123/256) of them. Death was reported in 110 patients, of which 28 (25.5%) were reported to be secondary to infections. Certain precautions should be used when using BsAbs to mitigate the risk and/or identify and treat infections promptly.