Clinical outcomes and risk factors of cytomegalovirus reactivation in teclistamab-treated multiple myeloma patients

Teclistamab, a bispecific T-cell engager targeting BCMA and CD3, has demonstrated efficacy in relapsed/refractory multiple myeloma but may increase infection risk due to immunosuppression. Cytomegalovirus (CMV) reactivation is a concern in immunocompromised patients, yet its incidence and clinical significance in teclistamab-treated patients remain poorly characterized. We conducted a retrospective analysis of 177 multiple myeloma patients who received teclistamab between December 2022 and December 2024. We assessed CMV reactivation incidence, risk factors, and clinical outcomes. Binary logistic regression identified predictors of CMV reactivation. CMV testing was done in 173 (98%) patients. CMV reactivation occurred in 38 patients (22%) during teclistamab treatment, with a median initial viral load of 87.2 IU/mL (range: 37.1-4807.0). The median highest CMV level was 288 IU/mL (range: 45.3-20,000). Most reactivations were asymptomatic (89.5%), with only four symptomatic cases, three requiring treatment, and no end-organ damage. Eight patients (21.1%) experienced second viremia episodes. Multivariable analysis identified prior CMV reactivation as a significant predictor (OR = 3.34, p = 0.005). CMV reactivation did not impact overall survival (p = 0.673). Prophylactic IVIG use was associated with improved survival (HR = 0.49, p = 0.011). CMV reactivation occurs in approximately one-fifth of teclistamab-treated multiple myeloma patients but is typically asymptomatic and does not affect survival. Prior CMV reactivation predicts subsequent reactivation. These findings support risk-stratified CMV monitoring approaches in this population.