Immunoglobulin supplementation and longer dosing intervals reduce risk of infections in patients with RRMM treated with teclistamab

Patients with relapsed/refractory multiple myeloma (RRMM) who are treated with BCMA-directed bispecific antibodies (BsAbs) are at an increased risk for infections. Previous studies have shown that treatment with intravenous immunoglobulin (IVIG) reduced the risk for severe infections. However, whether IVIG also reduces all-grade infections and whether there is an impact of longer dosing intervals on infection risk remains unknown. To address this, we retrospectively investigated 80 patients with RRMM who were treated with teclistamab in a single center. After a median follow-up of 21 months, in total 390 infections were reported, of which 48 were severe. Treatment with IVIG resulted in significantly lower rates of both severe infections (0.33 vs. 0.93 per patient-year) as well as of all-grade infections (3.15 vs. 4.41 per patient-year). Multivariable analyses revealed that older age and higher beta-2-microglobulin levels were associated with an increased risk of severe breakthrough infections during IVIG supplementation. Importantly, longer dosing intervals reduced infection rates for all-grade infections (from 6.08 infections per patient-year during weekly dosing to 2.25 infections per patient-year during bimonthly dosing) and for severe infections (from 0.81 infections per patient-year during weekly dosing to 0.1 per patient-year during bimonthly dosing). These results underline the importance of the assessment of annualized infection rates to reflect the true infectious burden in patients who were treated with BCMA-directed BsAbs.