Multiple Myeloma (MM) is a malignancy characterized by abnormal production of monoclonal immunoglobulins in plasma cells. Bispecific antibodies have emerged as a significant advancement in MM treatment, offering high effectiveness and specificity by targeting different antigens such as BCMA, CD38, and FcRH5. However, the risk of infection poses a major challenge in MM patients, which is thought to be influenced by various factors.The overall risk of infections associated with the use of BsAbs is estimated to be approximately 56% for all grades, with Grade 3/4 infections accounting for 24% of cases. Notably, BCMA-targeted BsAbs are associated with a higher incidence of infections compared to other targets. Risk factors contributing to infection occurrence include BsAbs risk of neutropenia and hypogammaglobulinemia as well as the inherent nature of the disease and patient-related factors. Bacterial infections, particularly respiratory tract and gastrointestinal infections are the most commonly reported, while viral infections such as CMV and rhinovirus are also prevalent in patients receiving BsAbs. Additionally, fungal infections have been documented in MM patients. Prophylactic measures for bacterial and fungal infections are tailored based on individual patient risk assessments, while viral infection prophylaxis is recommended for all refractory/relapsed MM patients receiving BsAbs.
Keywords: Infections; Multiple myeloma; bispecific antibodies; hypogammaglobulinemia; lymphopenia; neutropenia; prevention; prophylaxis.
Multiple myeloma (MM) is a malignancy of plasma cells characterized by the abnormal production of monoclonal immunoglobulins. Despite advancements in treatment modalities, MM remains an incurable disease.Bispecific Antibodies (BsAbs) have emerged as a significant advancement in the treatment of MM. However, patients with MM are still at a higher risk of infection due to the immunosuppressive nature of the underlying disease.The high infection rate associated with the use of BsAbs in MM poses a significant challenge. It is believed to have multiple contributing factors. Despite the preventive recommendations provided by oncology-related agencies, there continues to be an increased incidence of infections. Therefore, it is crucial to understand the frequency and nature of these infections to effectively manage them.Antibiotic, antifungal and Pneumocystis Jiroveci Pneumonia (PJP) prophylaxis are indicated in specific cases to mitigate the risk of infection.Being aware of the risk of infections that are associated with BsAbs can help us be more cautious in screening and implementing preventive measures. Moreover, such information could be a building block for future researchers to compare the risk of infections between different treatment classes. This review will focus on the risk of infection with BsAbs along with the risk factors that might increase the odds of infection, as well as the recommended measures to decrease the chance of infections in MM patients who are receiving these agents.