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IVIG Supplementation Reduces Infection Risk in Patients With Multiple Myeloma Receiving Teclistamab
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Key Takeaways
- Teclistamab effectively treats MM but has a high infection rate, with 79% of patients experiencing infections.
- IVIG supplementation reduces high-grade infection risk in teclistamab-treated patients, with primary prophylaxis showing significant benefits.
For patients with multiple myeloma who may experience an infection while receiving teclistamab, supplementation with intravenous immunoglobulin (IVIG) can help resolve and prevent serious complications.
In patients with multiple myeloma (MM) receiving treatment with teclistamab, primary supplementation with intravenous immunoglobulin (IVIG) was found to reduce the risk of high-grade infectious complications, with more recent IVIG administration further lowering the risk of infection, according to an oral abstract published in Blood and presented at the 66th American Society of Hematology (ASH) Annual Meeting.1
Patients with multiple myeloma using teclistamab may experience serious infections, for which IVIG supplementation can play a role. | Image Credit: © LELISAT | stock.adobe.com
Teclistamab demonstrated effectiveness in treating patients with MM, showing durable and deep responses in this patient population in multiple trials. In the MajesTEC-1 trial (NCT04557098), which featured the longest follow-up of any bispecific antibody in MM to that point, teclistamab led to a duration of response of 18.4 in patients with MM. However, infections were common; 79% of patients enrolled in the trial experienced an infection, with 55% of these individuals experiencing a high-grade infection.2
Previous research demonstrated the effectiveness of IVIG use in patients with serious infections induced by treatment with bispecific antibodies such as teclistamab. One trial found a 90% decrease in the rate of grade 3 to 5 infections during periods when patients were receiving IVIG compared to when they were not. Still, a lack of a clear consensus on the optimal timing of IVIG initiation remains. Therefore, the current investigators sought to examine the effect of IVIG supplementation on infectious complications in teclistamab recipients in a multi-institutional trial.1,3
All patients with MM treated with at least 1 dose of teclistamab at 4 academic centers across the United States were included in the trial. In total, 168 patients—with a median follow up of 8.5 months—were included in the trial. The median age of the trial population was 70, with 49% of patients aged 70 years or older. Furthermore, the median duration of teclistamab therapy was 4.6 months, while the median doses of the medication was 15. A total of 71 patients (42%) received IVIG, with the majority receiving primary IVIG prophylaxis, defined as administering IVIG within 60 days of starting teclistamab or prior to the first documented infection.1
For patients who did not receive IVIG, those on primary IVIG prophylaxis, and those on secondary IVIG prophylaxis, the 3-month cumulative incidences of all grade infection were 49% (95% CI, 39%-61%), 36% (95% CI, 26%-50%), and 38% (95% CI, 15%-92%), respectively. Regarding the incidence of infections that are grade 3 or higher, patients receiving primary IVIG prophylaxis had an incidence of 9.8% (95% CI, 4.6%-21%) compared with 38% (95% CI, 15%-92%) and 32% (95% CI, 23%-43%) in patients receiving secondary prophylaxis and no IVIG, respectively, according to the investigators.1
Further analysis was conducted related to the timing of a patient’s last dose of IVIG. The investigators used Cox regression modeling to compare patients who did not receive IVIG to those whose latest dose was within the last 30 days. The analysis revealed that receiving a dose over the past 30 days lowers the hazard of infection 0.59-fold (I = .018). Additionally, the effects of IVIG were demonstrably stronger against bacterial infections earlier (HR: 0.42; 95% CI, 0.23-0.77) compared with later time points of 31 to 60 days and over 60 days.1
In an important discovery, the investigators observed certain other factors that are associated with an increased risk of infection through a multi-variate analysis. These included the use of tocilizumab (Actemra; Genentech) for cytokine release syndrome (HR: 1.54; 95% CI, 1.07-2.21) and the number of prior infections (HR: 1.30; 95% CI, 1.14-1.50).1
The study authors noted the need for a cost effectiveness analysis, writing that one was currently in progress. They also advocated for further studies “to identify patients at highest risk of infections, allowing for more targeted IVIG therapy adjustments.”1
