Managing Infections During Bispecific Therapy for Multiple Myeloma

EP: 1.Goals and Efficacy of the MajesTEC-1 Trial in Multiple Myeloma

Now Viewing

EP: 2.Managing Infections During Bispecific Therapy for Multiple Myeloma

EP: 3.Bispecific T-Cell Engagers Improve Immune Response in Multiple Myeloma

EP: 4.BCMA Therapies Changing Treatment in Relapsed/Refractory Multiple Myeloma

EP: 5.Teclistamab Provides a Superior Response for Patients with R/R Multiple Myeloma

EP: 6.Strategies for Patients with Relapsed/Refractory Multiple Myeloma

EP: 7.MajesTEC-1 Results Show Efficacy for Teclistamab in Multiple Myeloma

EP: 8.Key Factors Influence Therapeutic Choices in Penta-Refractory Myeloma

EP: 9.Physicians Share Perceptions of BCMA-Targeted Therapies for Multiple Myeloma

EP: 10.Long-Term Depth of Response With Teclistamab Continues in RRMM

EP: 11.Teclistamab Toxicities Highly Manageable in R/R Multiple Myeloma

EP: 12.Targeting BCMA With Teclistamab Produces Impactful Results in RRMM

EP: 13.Manageable Toxicities Allow For Flexible Treatment in RRMM

EP: 14.Teclistamab Shows Strong Efficacy in Triple-Refractory Multiple Myeloma

EP: 15.Elranatamab Shows Efficacy of BCMA-Targeted Therapy in Multiple Myeloma

Shaji Kumar, MD, a professor of medicine and a consultant in the division of hematology at Mayo Clinic in Rochester, Minnesota, discusses the incidence and management of infections in patients receiving teclistamab-cqyv (Tecvayli) or other bispecific agents for relapsed/refractory multiple myeloma.

Teclistamab, a B-cell maturation antigen [BCMA­]–targeted bispecific T-cell engager, was approved based on the phase 1/2 MajesTEC-1 trial (NCT03145181; NCT04557098). One significant adverse event (AE) reported in the trial was infection, which occurred in 76.4% of patients, with 44.8% reporting grade 3 or 4 infections. Kumar says that opportunistic infections are seen in patients who are heavily immunosuppressed due to the disease and the effect of therapies. He says this makes it important to monitor patients as they receive teclistamab in routine practice.

Risk of infection may be related to BCMA-targeted therapies depleting B cells and plasma cells, leading to hypogammaglobulinemia, which was reported in 74.5% of patients in the trial. Kumar says that identifying infections early and giving intravenous immune globulin (IVIG) to patients who have low serum immunoglobin are important management practices for teclistamab.

TRANSCRIPTION:

0:08 | One important set of [AEs] that has been noted with teclistamab and other bispecific antibodies has been infections. Now [over] two-thirds of the patients on teclistamab had infections and almost half of them—that means a third of the patients got a grade 3 or 4 infection. Now what has been concerning is some of these infections are what we call opportunistic infections that are seen in heavily immunosuppressed patients. So clearly, we need to get a better handle on that particular set of AEs. And I think careful monitoring as patients start getting this drug in the routine practice is going to be very important.

0:48 | Now part of that is probably related to the fact that the BCMA is also present on the B cells and these therapies lead to profound depletion of the B cell population, and normal plasma cells, leading to significant hypogammaglobulinemia. So identifying infections early on, treating them aggressively, as well as trying to prevent infections with IVIG infusions in patients who are profoundly hypogammaglobulinemic, all are going to be important part of the management of these patients.