Optimal infection prophylaxis strategy for relapsed/refractory multiple myeloma patients undergoing elranatamab therapy (OPTIMUS-EL)
Abstract
Background: Relapsed/refractory multiple myeloma (MM) patients are at an increased risk of infectiondue to the immunsuppressive nature of the disease and the host factors. Albeit their excellent efficacy outcomes, bispecific antibodies (BsAbs), especially those targeting BCMA, increase the risk of infection significantly. Specifically, atypical infections including viral infections are becoming a big problem. Seroprevalence of latent viruses and determinants for opportunistic infections differ per region, thus it is important to comprehensively understand the similarities and differences amongst patients undergoing the same treatment. More specifically, cytomegalovirus (CMV) is endemic across many Asian countries, South American and African countries. CMV is one of the most important complications in immunocompromised patients. It can cause multi-organ disease, including pneumonia, gastroenteritis, retinitis and encephalitis. For patients undergoing BCMA BsAbs treatment, the reported clinically significant CMV infection risk ranges from 13% to 39.4%, and the reactivation rate 66.7%. Putting this into context, the reported clinically significant CMV infection risk is 41.8% without prophylaxis for patients undergoing hematopoietic stem cell transplantation. This similar rate of CMV related events clearly calls for an action. Unfortunately, even in the most recent IMWG guideline there are varied views on CMV related items including prophylactic schema.
As BsAbs prolong survival…
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