Multiple Myeloma Patients Treated with Teclistamab May Benefit from IVIG Supplementation

Results of a recent study show patients with multiple myeloma (MM) undergoing teclistamab therapy may benefit from primary intravenous immune globulin (IVIG) supplementation, which appears to reduce the risk of high-grade infection. Furthermore, IVIG may benefit patients receiving this therapy within the 30 days leading up to data cutoff.

Data from patients who received at least one dose of teclistamab at one of four academic centers in the U.S. were included in the study. The authors distinguished between primary and secondary IVIG; in the former, patients received IVIG within the first 60 days of initiating teclistamab, while in the latter, patients initiated IVIG prior to teclistamab. Patients who developed an infection prior to receiving IVIG, however, were classified as not receiving IVIG prophylaxis.

Overall, data from 168 patients were included. The median age of patients was 70 years, 25 percent of whom were African American, and the median number of prior therapy lines was five. Most (95 percent) patients received at least one prior stem cell transplantation. The median follow-up was 8.5 months. At this point, data showed that the median duration of teclistamab therapy was 4.6 months; the median number of prior therapy doses was five. Analysis showed that 42 percent of patients received IVIG, with 63 of these 71 patients receiving primary IVIG. The most common IVIG dosing schedule was 0.4 mg/kg every four weeks.

Results showed that 181 infections occurred in 92 patients, 53 percent of which were bacterial and 42 percent of which were viral; nine fungal infections were also noted in seven patients. Among the infections, 55 percent were grade 3 or worse and 57 percent required hospitalization. Analysis of data from the overall cohort showed that the three-month cumulative incidence for any infection was 43 percent, and the three-month incidence of grade 3 or worse infection was 23 percent.

Subgroup analysis suggested that patients who did not receive IVIG had a three-month cumulative infection incidence rate of 49 percent, whereas patients who received primary or secondary IVIG had three-month cumulative infection rates of 36 percent and 38 percent, respectively, though the difference was not significant.

Grade 3 or worse infections did, however, occur at a lower rate among patients who received primary IVIG (9.8 percent) than among patients who received secondary IVIG (38 percent) or no IVIG (32% percent).

Univariate analysis suggested, furthermore, that having had a last IVIG dose within the preceding 30 days to data cutoff reduced the risk of infection by approximately 0.59 compared with no IVIG. Other timescales in final dosing did not reach statistical significance.

According to the researchers, future studies are necessary to identify patients at highest risk of infections, allowing for more targeted IVIG therapy adjustments.