Clinical Scorecard: Guidelines for Infection Management, Preventive Measures, and Treatment in Multiple Myeloma Patients Undergoing Bispecific Antibody Therapy: Expert Panel Consensus

At a Glance

Key Highlights

• BsAbs targeting BCMA and other MM-specific antigens are emerging therapies with accelerated approvals for RRMM.
• BsAb therapy is associated with increased infection risk, including opportunistic infections due to immune impairment.
• Expert consensus guidelines provide recommendations on infection diagnosis, prophylaxis, monitoring, and management.

Guideline-Based Recommendations

Diagnosis

• Monitor for infections including bacterial, viral (CMV, HBV), and opportunistic pathogens (PJP) in BsAb-treated patients.
• Use clinical and laboratory assessments to identify infection-related adverse events such as CRS and cytopenias.

Management

• Implement infection prophylaxis tailored to infection risks associated with BsAb therapy and MM immune dysfunction.
• Treat infections promptly considering the immunosuppressed status and potential for severe complications.

Monitoring & Follow-up

• Regularly assess immune parameters including immunoglobulin levels and cytopenias during BsAb treatment.
• Surveillance for viral reactivation (CMV, HBV) and opportunistic infections is recommended.

Risks

• Increased infection rates (33%-76%) observed with BCMA-targeting BsAbs due to immune modulation.
• Risks include cytokine release syndrome, neurotoxicity, cytopenias, hypogammaglobulinemia, and opportunistic infections.

Patient & Prescribing Data

Adult patients with relapsed/refractory multiple myeloma, including those refractory to IMiDs, PIs, and anti-CD38 antibodies

Teclistamab and elranatamab have received regulatory approvals or designations; infection risk management is critical during BsAb therapy.

Clinical Best Practices

• Conduct thorough infection risk assessment prior to and during BsAb therapy.
• Apply prophylactic antimicrobial strategies based on individual patient risk and emerging clinical evidence.
• Engage multidisciplinary teams including infectious disease specialists for optimal infection management.
• Educate patients on infection signs and the importance of prompt reporting.
• Use consensus grading levels to guide clinical decision-making and adapt recommendations as new data emerge.

References

• European Medicines Agency approval of teclistamab
• FDA accelerated approval of teclistamab
• Expert consensus on BsAb infection management in MM