Improving outcomes with anti-BCMA bispecific antibodies with attention to infection
Andrew J. Yee
Abstract
Therapies targeting BCMA are transforming the care of multiple myeloma, with unprecedented depth and durability of responses in patients with heavily treated disease. The field is moving rapidly, especially with the recent approval of anti-BCMA CAR T-cells in as early as one prior line of therapy with ciltacabtagene autoleucel (cilta-cel) and two prior lines of therapy with idecabtagene vicleucel. While patients are benefiting from the efficacy of these treatments, there is also growing data on the increased risk of infections with these therapies. In the initial trials of teclistamab (MajesTEC-1) and elranatamab (MagnetisMM-3), infections (all grade; grade 3–4; grade 5) were common with teclistamab (80%; 55.2%; 12.7%) and elranatamab (69.9%; 39.8%; 6.5%), respectively [ 1 , 2 , 3 ]. By comparison, infections were lower in the CARTITUDE-1 trial of anti-BCMA CAR T-cells cilta-cel (58%; 20%; 3%) [ 4 , 5 ]. In the bispecific antibody trials, hypogammaglobulinemia (IgG <400 mg/dL) was also frequent with teclistamab (70.9%) and elranatamab (75.5%) [ 2 , 3 ]. Moreover, opportunistic infections with Pneumocystis jirovecii and reactivation or infection with cytomegalovirus virus were seen on these trials.