Dr Raab on Safety and Infection Prophylaxis With Daratumumab-Based Induction Regimens in Myeloma

"Infection prophylaxis is a key point if you combine a BCMA-targeting bispecific antibody with SOC drugs. Giving IVIG prophylactically... is key to keeping those rates as low as possible."

Marc S. Raab, MD, a professor of medicine and clinical director of the Heidelberg Myeloma Center in the Department of Medicine V at Heidelberg University Hospital, CCU Molecular Hematology/Oncology, German Cancer Research Center, shared safety data with teclistamab plus daratumumab (Darzalex) and lenalidomide (Revlimid) with or without bortezomib (Velcade) from the phase 2 MajesTEC-5 trial (NCT05695508), and emphasized the importance of infection prophylaxis when administering this regimen to patients with newly diagnosed multiple myeloma.

Findings shared during the 22nd Annual International Myeloma Society (IMS) Meeting and Exposition showed that all patients who received teclistamab every week in combination with daratumumab and lenalidomide (Tec-DR; arm A; n = 10), Tec-DR with teclistamab every 4 weeks (arm A1; n = 20) or teclistamab plus daratumumab, bortezomib, and lenalidomide (Tec-DVR; arm B; n = 19) achieved overall responses.

Although the overall safety profile was manageable across arms, Raab emphasized the crucial need to monitor infection rates when utilizing BCMA-directed bispecific antibodies, particularly in combination regimens. Of note, the initial rate of grade 3 or 4 infection presented at the 2024 ASH Annual Meeting was 34.7%. With longer follow-up, this rate slightly increased to 36.7%, indicating only one additional grade 3 or 4 infection was reported in one additional patient. Notably, no grade 5 infections occurred, and no patients were required to discontinue the study specifically due to infections.

However, due to the persistent risk of infection associated with this class of therapy, Raab stressed that infection prophylaxis is a crucial aspect of management when combining a BCMA-targeting bispecific antibody like teclistamab with SOC drugs. Key prophylactic measures required to minimize infection rates include administering IVIG prophylactically, along with prophylaxis against Pneumocystis pneumonia, anti-Zoster prophylaxis, and general antiviral prophylaxis, he concluded.