Rahul Banerjee: High Infection Risk With bsAbs in Myeloma
Rahul Banerjee, Assistant Professor at Fred Hutchinson Cancer Center at the University of Washington, shared a post on X, about a recent article he and his colleagues co-authored, adding:
“Our call to action is out in Blood Advances.
Title speaks for itself. Given concerningly high infection risk with bsAbs in myeloma, IVIG/SCIG should be started regardless of any IgG threshold.
Global authors and global audience, including insurance and healthcare funders.
We delineate between these two:
- Primary IVIG/SCIG PPx: Start during C1 regardless of IgG level
- Preemptive IgG replacement: Restrict IVIG/SCIG until IgG < 400 mg/dL (4 g/L)
IgG levels can be misleading and don’t guarantee protection against circulating pathogens.
Some would argue that we’d need RCT of primary PPx versus preemptive replacement (give if IgG <400 mg/dL) to prove tihs.
Our counterpoint – writing’s already on the wall. Infection risk with bsAbs in MM (esp BCMA) much too high, and IgG 400 not scientifically based.
For concerning safety risk, effective strategies worthwhile even if expensive. No RCT needed, just like no RCT ever done re: toci for CRS.
IVIG quite expensive, but benefits outweigh costs here given increased risk of Gr3+ infections.
Global perspective SCIG may be a winner!
Thanks to amazing co-authors Meera Mohan, Kai Rejeski, Gurbakhash Kaur, Shonali Midha, Georgia McCaughan, Nikhil Kumar, Nikita Mehra, Bhausaheb Bagal for global perspective and mentor Noopur Raje for wisdom.
Bottom line – if healthcare payers have the reaction below, show them our Blood Advances article!”
Title: IVIG prophylaxis should be initiated following bispecific antibody therapy in multiple myeloma regardless of IgG levels
Authors: Rahul Banerjee, Meera Mohan, Kai Rejeski, Benjamin R. Puliafito, Diana D. Cirstea, Gurbakhash Kaur, Shonali Midha, Georgia J McCaughan, Nikhil M Kumar, Nikita Mehra, Bhausaheb Bagal, Noopur S. Raje
Read the Full Article on Blood Advances
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