Effect of Intravenous Immunoglobulin (IVIG) Supplementation on infection-free survival in recipients of BCMA-directed bispecific antibody therapy for multiple myeloma
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. Th...
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Nature Publishing Group
2025-04-01
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| Series: | Blood Cancer Journal |
| Online Access: | https://doi.org/10.1038/s41408-025-01282-0 |
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| author | Meera Mohan Aniko Szabo Heloise Cheruvalath Anna Clennon Vineel Bhatlapenumarthi Anannya Patwari Metodi Balev Divaya Bhutani Asis Shrestha Sharmilan Thanendrarajan Binod Dhakal Maurizio Zangari Anup Trikannad Sruthi Vellanki Samer Al-Hadidi Suzanne Lentzsch Frits van Rhee Aishee Bag Anita D’Souza Nishi Shah Rajshekhar Chakraborty Mansi R. Shah Carolina Schinke |
| author_facet | Meera Mohan Aniko Szabo Heloise Cheruvalath Anna Clennon Vineel Bhatlapenumarthi Anannya Patwari Metodi Balev Divaya Bhutani Asis Shrestha Sharmilan Thanendrarajan Binod Dhakal Maurizio Zangari Anup Trikannad Sruthi Vellanki Samer Al-Hadidi Suzanne Lentzsch Frits van Rhee Aishee Bag Anita D’Souza Nishi Shah Rajshekhar Chakraborty Mansi R. Shah Carolina Schinke |
| author_sort | Meera Mohan |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-28c11891327b469f96b1f6a2fcd7e059 |
| institution | DOAJ |
| issn | 2044-5385 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Nature Publishing Group |
| record_format | Article |
| series | Blood Cancer Journal |
| spelling | doaj-art-28c11891327b469f96b1f6a2fcd7e0592025-08-20T03:14:07ZengNature Publishing GroupBlood Cancer Journal2044-53852025-04-011511810.1038/s41408-025-01282-0Effect of Intravenous Immunoglobulin (IVIG) Supplementation on infection-free survival in recipients of BCMA-directed bispecific antibody therapy for multiple myelomaMeera Mohan0Aniko Szabo1Heloise Cheruvalath2Anna Clennon3Vineel Bhatlapenumarthi4Anannya Patwari5Metodi Balev6Divaya Bhutani7Asis Shrestha8Sharmilan Thanendrarajan9Binod Dhakal10Maurizio Zangari11Anup Trikannad12Sruthi Vellanki13Samer Al-Hadidi14Suzanne Lentzsch15Frits van Rhee16Aishee Bag17Anita D’Souza18Nishi Shah19Rajshekhar Chakraborty20Mansi R. Shah21Carolina Schinke22Division of Hematology/Oncology, Department of Medicine, Medical College of WisconsinDivision of Biostatistics, Data Science Institute, Medical College of WisconsinMedical College of Wisconsin Medical SchoolHematology Oncology, Aurora St. Luke’s Medical CenterDivision of Hematology/Oncology, Department of Medicine, Medical College of WisconsinDivision of Hematology/Oncology, Department of Medicine, Medical College of WisconsinMultiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer CenterMultiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer CenterMyeloma Center, University of Arkansas for Medical ScienceMyeloma Center, University of Arkansas for Medical ScienceDivision of Hematology/Oncology, Department of Medicine, Medical College of WisconsinMyeloma Center, University of Arkansas for Medical ScienceMyeloma Center, University of Arkansas for Medical ScienceMyeloma Center, University of Arkansas for Medical ScienceMyeloma Center, University of Arkansas for Medical ScienceMultiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer CenterMyeloma Center, University of Arkansas for Medical ScienceDivision of Blood Disorders, Rutgers Cancer Institute of New JerseyDivision of Hematology/Oncology, Department of Medicine, Medical College of WisconsinDivision of Hematological Malignancies, Department of Oncology, Montefiore Medical Center and Albert Einstein College of MedicineMultiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer CenterDivision of Blood Disorders, Rutgers Cancer Institute of New JerseyMyeloma Center, University of Arkansas for Medical ScienceAbstract 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.https://doi.org/10.1038/s41408-025-01282-0 |
| spellingShingle | Meera Mohan Aniko Szabo Heloise Cheruvalath Anna Clennon Vineel Bhatlapenumarthi Anannya Patwari Metodi Balev Divaya Bhutani Asis Shrestha Sharmilan Thanendrarajan Binod Dhakal Maurizio Zangari Anup Trikannad Sruthi Vellanki Samer Al-Hadidi Suzanne Lentzsch Frits van Rhee Aishee Bag Anita D’Souza Nishi Shah Rajshekhar Chakraborty Mansi R. Shah Carolina Schinke Effect of Intravenous Immunoglobulin (IVIG) Supplementation on infection-free survival in recipients of BCMA-directed bispecific antibody therapy for multiple myeloma Blood Cancer Journal |
| title | Effect of Intravenous Immunoglobulin (IVIG) Supplementation on infection-free survival in recipients of BCMA-directed bispecific antibody therapy for multiple myeloma |
| title_full | Effect of Intravenous Immunoglobulin (IVIG) Supplementation on infection-free survival in recipients of BCMA-directed bispecific antibody therapy for multiple myeloma |
| title_fullStr | Effect of Intravenous Immunoglobulin (IVIG) Supplementation on infection-free survival in recipients of BCMA-directed bispecific antibody therapy for multiple myeloma |
| title_full_unstemmed | Effect of Intravenous Immunoglobulin (IVIG) Supplementation on infection-free survival in recipients of BCMA-directed bispecific antibody therapy for multiple myeloma |
| title_short | Effect of Intravenous Immunoglobulin (IVIG) Supplementation on infection-free survival in recipients of BCMA-directed bispecific antibody therapy for multiple myeloma |
| title_sort | effect of intravenous immunoglobulin ivig supplementation on infection free survival in recipients of bcma directed bispecific antibody therapy for multiple myeloma |
| url | https://doi.org/10.1038/s41408-025-01282-0 |
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