IVIG Reduces Infections Following BsAB Therapies in Multiple Myeloma Patients

A recent study showed treatment with intravenous immune globulin (IVIG) following infection from BCMA therapies yielded a 67 percent decrease in infections in patients with multiple myeloma (MM). BCMA is a highly expressed protein found in approximately 90 percent of all patients with MM; however, BCMA bispecific antibody (BsAb) therapies, among other treatment options, are associated with increased risk of infections due to lowered humoral immunity.

In the study, researchers performed a retrospective analysis of de-identified electronic health records from Epic Cosmos, covering more than 1,700 hospitals and 40,000 clinics in the United States. The assessment included patients with MM (n=1646; >18 years of age) who received more than two doses of elranatamab (n=155) or teclistamab (n=1,491) who were followed from first to last administration. The median age at the time of initiation of treatment was 70 years (IQR, 63-76). Of the population, 881 (53.5 percent) were male and 1,042 (63.3 percent) identified as White. The majority of patients lived in urban areas (n=1402, 86 percent). Median time from diagnosis to treatment initiation was 4.7 years (IQR, 2.3–7.5).

The researchers used the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes to identify infection events. Episodes were counted as separate if they were represented by different ICD codes or occurred more than 56 days apart. Analyses included calculating the proportion of patients who experienced each toxicity type, determining toxicity incidence rates and measuring time to first toxicity. Infection rates before and after IVIG treatment were evaluated using a paired t-test.

According to the researchers, 30 percent of patients had at least one infection at a rate of 0.06 (standard deviation [SD], 0.27) episodes per patient-month with a median time to infection of 0.06 (SD, 0.27) episodes per patient-month of two months (IQR, 0.7–5.1). The most common infection was bacterial sepsis (n=200, 12.2 percent), followed by febrile neutropenia (n=126, 7.7 percent) and viral pneumonia (n=89, 5.4 percent). Patients treated with teclistamab showed a higher risk of infection (n=458, 30.7 percent) compared with patients treated with elranatamab (n=35, 22.6 percent; P=0.03).

Treatment with IVIG led to notable results. A little more than half of patients (50.2 percent) received IVIG during BsAb treatment. Among these patients, the infection rate decreased from 0.27 episodes per patient-month (SD, 0.27) before IVIG to 0.03 episodes per patient-month (SD, 0.15) after IVIG (P<.001).

“In this largest nationwide cohort of MM patients treated with anti-BCMA BsAb, only half of the patients received IVIG, and use of IVIG was associated with a 67 percent decrease in infections,” the study’s authors concluded. “More awareness is needed to expand the use of IVIG to prevent infections in patients receiving BsAbs, and prospective studies would be crucial to establish its optimal dosing schedules.”