Infections are common among patients with relapsed or refractory multiple myeloma (MM) treated with bispecific antibodies, according to a pooled analysis published in Blood Advances

The analysis included data from 11 trials with a total of 1185 patients who had relapsed or refractory MM. Most patients were treated with a BCMA-targeted bispecific antibody (71.6%). 

At a median follow-up of 6.1 months, 50% of patients had infections, and 24.5% had grade 3-4 infections. 

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Patients treated with BCMA-targeted bispecific antibodies had a higher rate of grade 3-4 infections than patients treated with other bispecific antibodies — 30% and 11.9%, respectively (P =.01). 

Typical infections included pneumonia, upper respiratory tract infections, adenovirus infections, central line-associated bloodstream infections, urinary tract infections, and Helicobacter pylori

Opportunistic infections included cytomegalovirus (CMV) infection/reactivation, Pneumocystis jiroveci pneumonia (PJP), Candida esophagitis, ophthalmic herpes simplex virus, and progressive multifocal leukoencephalopathy (PML). 

Different infections were seen with different bispecific antibodies. For example, patients taking teclistamab had adenovirus, Streptococcus pneumonia, COVID-19, PJP, and PML. Patients taking elranatamab had Pseudomonas pneumonia, CMV, and COVID-19.

There were 110 deaths in this cohort, and 25.5% were secondary to infection. Fatal infections included COVID-19, Streptococcus pneumonia, Pseudomonas pneumonia, influenza, aspergillosis, hepatitis, pneumonia due to adenovirus, and sepsis due to an unidentified organism. 

“Certain precautions should be used when using BsAbs [bispecific antibodies] to mitigate the risk and/or identify and treat infections promptly,” the researchers wrote. “Limited duration of treatment with less frequent dosing may result in better outcomes and lower risk of complications.”


Mazahreh F, Mazahreh L, Schinke C, et al. Risk of infections associated with the use of bispecific antibodies in multiple myeloma: A pooled analysis. Blood Adv. Published online March 1, 2023. doi:10.1182/bloodadvances.2022009435