Managing Infection Risk With Bispecific Antibodies in Myeloma

Managing infection risk is essential for patients receiving bispecific antibodies for multiple myeloma, as these therapies can impact the immune system, explained Beth Faiman, PhD, MSN, APN-BC, BMTCN, AOCN, FAAN, FAPO, a nurse practitioner at Cleveland Clinic Taussig Cancer Institute in Ohio.

Faiman shared in an interview with Oncology Nursing News, following her presentation on novel therapies in hematology oncology at the 9^th Annual School of Nursing Oncology, hosted by Physicians’ Education Resource®, LLC, that bispecific antibodies in multiple myeloma target B-cell maturation antigen (BCMA), which plays a role in humoral immunity. By engaging T cells and directing them to attack BCMA-expressing cells, these therapies can compromise infection defense mechanisms, placing patients at increased risk.

Faiman emphasized the importance of prophylactic strategies. She recommended continuing antiviral prophylaxis with acyclovir or valacyclovir, monitoring hepatitis B surface antigen approximately every 6 months, and initiating antibacterial prophylaxis for patients who become neutropenic. Although neutropenia tends to occur early in treatment, antifungal prophylaxis may be needed for those with consistently low blood counts. For community oncology providers, understanding these mechanisms and proactive measures is key to optimizing patient outcomes while minimizing infection-related complications.

Transcript

In patients who have hematologic cancers that are undergoing CAR T-cell therapy, it is a bit different long term than bispecific antibodies. First of all, let’s talk about bispecific antibodies. In multiple myeloma, it targets the B-cell maturation antigen, or BCMA. BCMA is expressed on healthy cells less than cancer cells, so when we’re targeting with the T cell, we’re engaging the T cell with the CD3 and causing programmed cell death.

But BCMA protects us from infections. That’s part of our humoral immunity, or basic immune system. For community providers, it’s important to understand the mechanism of how the drug works and that you’re going to have a lowered immune system.

Short-term with bispecific antibodies, we can extend the dosing interval, maybe give them a little bit longer, but I’m still keeping patients on the antiviral prophylaxis for shingles with acyclovir and valacyclovir. We’re still looking at hepatitis B surface antigen regularly—about every 6 months—to make sure their hepatitis B status hasn’t changed, and we’re also doing antibacterial prophylaxis for neutropenic patients. Fortunately, with bispecific antibodies, that may be in the very beginning of treatment, but then long term, it’s not an issue. Then sometimes, they need antifungal prophylaxis if their blood counts stay very low.

This transcript has been edited for clarity and conciseness.