Identifying and Managing Infections in BCMA Therapy in Multiple Myeloma

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

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.