Cytomegalovirus reactivation during treatment with bispecific antibodies for relapsed/refractory multiple myeloma
By
Eric Jurgens
Tala Shekarkhand
Colin Rueda
David Nemirovsky
Andriy Derkach
Ross S. Firestone
Kevin Miller
Bruno Almeida Costa
Sridevi Rajeeve
Alexander M. Lesokhin
Neha Korde
Carlyn R. Tan
Hamza Hashmi
Hani Hassoun
Kylee Maclachlan
Urvi A. Shah
Malin Hultcrantz
Issam Hamadeh
Sergio A. Giralt
Gunjan L. Shah
Heather J. Landau
Michael Scordo
Saad Z. Usmani
Sham Mailankody
Zainab Shahid
November 1, 2025
Clinical Scorecard: Reactivation of Cytomegalovirus in Patients Undergoing Bispecific Antibody Therapy for Relapsed/Refractory Multiple Myeloma
At a Glance
Category Detail
Condition Cytomegalovirus (CMV) reactivation during bispecific antibody therapy Key Mechanisms CMV reactivation detected by serum CMV DNA PCR during BsAb therapy; steroid use increases risk Target Population CMV seropositive patients with relapsed/refractory multiple myeloma receiving BsAbs Care Setting Oncology treatment centers administering bispecific antibody therapy
Key Highlights
CMV reactivation occurred in 28% of patients at Day 90 and 36% at Day 180 during BsAb therapy. Steroid treatment for cytokine release syndrome was associated with increased risk of CMV detection (HR 3.11). Clinically significant CMV infection occurred in 4 patients, successfully treated with antiviral therapy. Guideline-Based Recommendations
Diagnosis
Perform baseline CMV IgG serostatus testing prior to BsAb therapy. Use serum CMV DNA PCR to monitor for CMV DNAemia and reactivation during treatment. Management
Initiate CMV-directed preemptive therapy for clinically significant CMV infection or high-level DNAemia (>1000 IU/mL). Treat CMV esophagitis and symptomatic reactivations with intravenous ganciclovir followed by oral valganciclovir. Monitoring & Follow-up
Implement regular CMV PCR surveillance during BsAb therapy, with median 4 tests per patient in follow-up. Monitor patients receiving steroids closely for CMV reactivation. Risks
Steroid use for CRS increases risk of CMV detection and possibly reactivation. Baseline hematologic parameters and IVIG prophylaxis were not associated with reduced CMV risk. Patient & Prescribing Data
85 CMV seropositive RRMM patients receiving teclistamab, talquetamab, or elranatamab
CMV reactivation is common; antiviral preemptive therapy is effective; BsAb therapy can be safely resumed after CMV resolution
Clinical Best Practices
Screen all RRMM patients for CMV serostatus before initiating BsAb therapy. Conduct routine CMV DNA PCR monitoring to detect early reactivation. Consider preemptive antiviral therapy for patients with significant CMV DNAemia or clinical disease. Be vigilant for CMV reactivation in patients receiving steroids for CRS. Maintain herpes simplex and varicella zoster virus prophylaxis during BsAb treatment. References
