Dr Shah on the Effects of IVIG on Teclistamab-Associated Infection Risk in Myeloma

“When we looked overall, the risk of developing infections was significantly lower in the IVIG group with the primary prophylaxis, particularly bacterial infections.”

Mansi R. Shah, MD, assistant professor, medicine, Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson (RWJ) Medical School; hematologist/oncologist, RWJ University Hospital, discusses a multi-institutional study of the effects of intravenous immunoglobulin (IVIG) supplementation on infection risk in recipients of teclistamab-cqyv (Tecvayli) therapy for multiple myeloma.

This study focused on patients with relapsed/refractory multiple myeloma receiving BCMA-targeted bispecific antibodies, Shah begins. The analysis was unique as it included patients enrolled in early-phase clinical trials of these therapies, allowing investigators to evaluate infection risks across different patient cohorts, according to Shah. Conducted as a retrospective study across 4 institutions, the data provided insights into infection prevention strategies in this heavily pretreated population, she reported.

The patient cohort had a median age of approximately 70 years, with over half of the participants being older than 70 years, Shah continues. On average, patients had undergone 5 prior lines of therapy (range, 2-12), and nearly all had received prior autologous stem cell transplant. The study assessed the effect of IVIG as either primary or secondary prophylaxis against infections, she explains. Primary prophylaxis was defined as IVIG administration within 60 days of BCMA-directed bispecific antibody initiation, whereas secondary prophylaxis was IVIG given after an infection had developed, Shah states. The findings revealed that patients who received primary prophylaxis had a significantly reduced risk of bacterial infections vs those who received secondary prophylaxis, with a hazard ratio of approximately 0.6. Conversely, secondary prophylaxis had a more limited effect on reducing infection risk, she emphasizes.

Secondary prophylaxis also demonstrated some benefit against the development of bacterial infections but did not influence the risk of developing other types of infections. These differences in infection prevention strategies were associated with improved overall survival and progression-free survival in patients receiving BCMA-targeted therapies, she says. However, infections remain a significant factor that could limit both treatment efficacy and dosing in this population, Shah concludes.