Linvoseltamab in Myeloma: Dr Orlowski on Managing Infectious Complications

Robert Orlowski, MD, PhD, professor of Medicine at The University of Texas MD Anderson Cancer Center, discusses prophylactic measures to manage infectious complications linked to T-cell engagers — namely linvoseltamab (Lynozyfic), a BCMAxCD3 bispecific antibody.

In an oral presentation at the 67th American Society of Hematology (ASH) Annual Meeting & Exposition, Orlowski reported findings from the phase 1/2 LINKER-MM4 trial (NCT05828511) showing linvoseltamab’s manageable safety profile as monotherapy for patients with newly diagnosed multiple myeloma. Here, a high rate of any-grade infections (84.4%) was observed among patients, with 33.3% classified as grades 3 to 4.

To mitigate these complications, standard practice dictates routine antiviral prophylaxis using agents such as acyclovir or valacyclovir. Orlowski also recommends monitoring of cytomegalovirus (CMV) levels as some patients may experience CMV reactivation, although he notes that this rate is generally low.

Orlowski also recommends administration of intravenous immunoglobulin (IVIG) as early as possible, noting that securing insurance approval for IVIG, especially for those with IgG myeloma, may be a hurdle. A practical suggestion for facilitating reimbursement in these cases is to assess IgG subclasses, which can serve as additional evidence supporting early IVIG treatment.