Preemptive Immunoglobulin Prophylaxis Reduces Infections in Patients Treated With Anti-BCMA Bispecific Antibodies

作者：Bénédicte Piron, Laura Rodrigo, Benoît Tessoulin, Thomas Gastinne, Viviane Dubruille, Valentin Letailleur, Chloé Antier, Anne Lok, Estelle Leroy, Philippe Moreau, Clémentine Fronteau, Cyrille Touzeau · 发表于：Clinical Lymphoma Myeloma & Leukemia · 年份：2025 · DOI：10.1016/j.clml.2025.10.024 · 被引用次数：3 · 研究领域：Monoclonal and Polyclonal Antibodies Research、Food Allergy and Anaphylaxis Research、Platelet Disorders and Treatments

BACKGROUND: Bispecific antibodies (BsAbs) targeting B-cell maturation antigen (BCMA) have improved outcomes for patients with relapsed/refractory multiple myeloma (MM). However, hypogammaglobulinemia driven by normal plasma cell depletion expose patients to high risk of infections. Immunoglobulin (IG) prophylaxis is recommended in patients receiving BsAbs and IgG level < 400 mg/dL. Real world evidence of the impact of preemptive IG prophylaxis remains limited. METHODS: We conducted a retrospective, single-center study including all consecutive MM patients receiving anti-BCMA BsAbs between December 2020 and May 2024. Patients started treatment before June 1, 2023, received IG as secondary prophylaxis. In contrast, patients treated after this date received preemptive IG prophylaxis if IgG level < 400 mg/dL in alignment with international recommendations. RESULTS: From Dec 2020 to June 2023, 42 patients received secondary IG prophylaxis with a median initiation time of 7.8 months from first anti-BCMA BsAb injection. From July 2023 to May 2024, 24 received preemptive IG prophylaxis with a median time to initiation of 1.6 months. During a 9-months observation period, patients in the preemptive IG group experienced a significant 66% reduction in all-grade infections (HR 0.34; 95% CI, 0.19-0.60; P = .0002) and 76% reduction in severe infections (HR 0.24; 95% CI, 0.08-0.69; P = .0084). Infections also occurred earlier without preemptive supplementation. CONCLUSION: This study support...