Characteristics and incidence of infections in patients with multiple myeloma treated by bispecific antibodies: a national retrospective study on the behalf of G2I and IFM.

Bispecific antibodies (BsAbs) are an effective treatment used in relapsed/refractory multiple myeloma. Despite a well-tolerated safety profile, infectious events appeared to be frequent in clinical trials. Real-world data on epidemiology, characteristics, risk factors and outcomes of infections in patients treated with BsAb are still needed. A retrospective, multicenter study in BsAb-treated MM patients was conducted in 14 French centers from December 2020 to February 2023. The primary objective was to describe the incidence of infections that required hospitalization, specific treatment, or adaptation in BsAb administration. Among 229 MM patients treated with BsAb, 153 (67%) received teclistamab, 47 (20%) received elranatamab and 29 (13%) talquetamab. We reported a total of 234 infections, including 123 (53%) of grade ≥3. Predominant infections affected the respiratory tract (n=116, 50%) followed by bacteremias (n=36, 15%). Hospitalization rate was 56% (n=131), and 20 (9%) infections resulted in death. Global cumulative incidence of first infection was 70% in all patients, 73% in patients treated with BCMA-targeting and 51% with GPRC5D-targeting BsAb. In univariate analyses, corticosteroids for CRS/ICANS were associated with a higher risk of first infection (HR=2.13; 95CI:1.38-3.28), while GPRC5D-targeting BsAb and antibacterial prophylaxis were associated with lower risk (HR=0.53; 95CI:0.3-0.94 and HR=0.65; 95CI:0.46-0.9). Fine and Gray multivariate model found that only corticosteroids for CRS/ICANS were correlated with a higher risk of first infection (HR=2.01; 95CI:1.27-3.19). The implementation of preventive measures that aim to mitigate the risk of infection under BsAb is pivotal, notably in patients who received corticosteroids for CRS/ICANS.

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