Effect of intravenous immunoglobulin (IVIG) supplementation on infection-free survival in recipients of BCMA-directed bispecific antibody therapy for multiple myeloma

Authors

Meera Mohan, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. memohan@mcw.edu.
Aniko Szabo, Division of Biostatistics, Data Science Institute, Medical College of Wisconsin, Milwaukee, WI, USA.
Heloise Cheruvalath, Medical College of Wisconsin Medical School, Milwaukee, WI, USA.
Anna Clennon, Advocate Health - MidwestFollow
Vineel Bhatlapenumarthi, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Anannya Patwari, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Metodi Balev, Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
Divaya Bhutani, Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
Asis Shrestha, Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA.
Sharmilan Thanendrarajan, Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA.
Binod Dhakal, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Maurizio Zangari, Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA.
Anup Trikannad, Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA.
Sruthi Vellanki, Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA.
Samer Al-Hadidi, Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA.
Suzanne Lentzsch, Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
Frits van Rhee, Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA.
Aishee Bag, Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Anita D'Souza, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Nishi Shah, Division of Hematological Malignancies, Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY, USA.
Rajshekhar Chakraborty, Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
Mansi R. Shah, Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Carolina Schinke, Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA.

Recommended Citation

Mohan M, Szabo A, Cheruvalath H, et al. Effect of Intravenous Immunoglobulin (IVIG) Supplementation on infection-free survival in recipients of BCMA-directed bispecific antibody therapy for multiple myeloma. Blood Cancer J. 2025;15(1):74. Published 2025 Apr 23. doi:10.1038/s41408-025-01282-0

Affiliations

Aurora St. Luke's Medical Center

Abstract

The main objective of this multi-institutional study is to understand the effect of primary intravenous immunoglobulin (IVIG) replacement on clinical outcomes in recipients of BCMA-directed bispecific antibody (bsAb), where infection remains an important cause of morbidity and mortality. This is a retrospective study of patients treated with either standard of care teclistamab or BCMA-directed investigational bsAb between Nov 2017 and Dec 2023. Primary IVIG prophylaxis was defined as starting IVIG prior to first documented infection. All analyses were adjusted for immortal-time bias inherent in this grouping. A total of 225 patients were included in this analysis. Primary IVIG prophylaxis was defined as starting IVIG prior to first documented infection. The median follow-up of patients treated with and without primary IVIG prophylaxis was, 9 and 11 months, respectively. The cumulative incidence of all grade infections at 12 months with and without primary IVIG prophylaxis were 56% (95%CI 40%,78%) and 60% (95% CI 48%, 76%); p = 0.72, respectively. The 12-month cumulative incidence of ≥ grade 3 infections was 35% (95% CI 21%, 57%) with primary IVIG prophylaxis and 45% (95% CI 34%, 60%) without; p = 0.37. The median infection free survival (IFS) for all-grade infections was 7.7 (95% CI 3.3, 14) months with primary IVIG prophylaxis and 3 (95% CI 2.6, 4.5) months without (p = 0.021). The median ≥ grade 3 IFS was 14 (95% CI 8.8, NR) and 7.5 (95% CI 6.1, 14) months, with and without primary IVIG respectively; p = 0.022. Patients on primary IVIG prophylaxis had a superior progression-free-survival (PFS) [median PFS 15 vs 8 months; p = 0.026] and overall-survival (OS) [median OS 16 vs 44 months; p = 0.007]. On multivariate analysis, primary IVIG prophylaxis was independently associated with improved OS (HR = 0.37; p = 0.021), while the presence of extra-medullary (HR = 2.71; p = <0.001) and high-risk disease (HR = 1.88; p = 0.031) conferred poor outcomes. In recipients of BCMA-directed bsAb, IVIG supplementation was associated with an improved clinical outcome, including favorable IFS and OS.

Document Type

Article

PubMed ID

40268898