Infection Prevention and Dosing Strategies for BCMA-Directed Bispecific Antibodies in Relapsed/Refractory Multiple Myeloma

The panel discusses strategies for managing toxicity and optimizing treatment duration with BCMA-directed therapies in relapsed/refractory multiple myeloma. Dr. Hans Lee and Dr. Douglas Sborov emphasize that belantamab mafodotin-associated ocular toxicity can be managed through dose and schedule modifications, with treatment interruptions used when needed while maintaining responses in responding patients. The discussion then focuses on infection prevention during bispecific antibody therapy. Dr. Jing Christine Ye describes the importance of immunoglobulin replacement, infectious disease screening, antiviral and Pneumocystis jirovecii pneumonia prophylaxis, antimicrobial prophylaxis when neutropenia occurs, and vaccination when appropriate. The panel also discusses maintaining immunoglobulin levels and the role of regular intravenous immunoglobulin replacement in reducing infection-related complications. Dr. Sborov highlights the potential for reducing bispecific dosing frequency over time, noting that many patients achieve responses early and may maintain those responses with less frequent administration. He describes a shift toward increasingly individualized dosing schedules and finite treatment approaches, particularly for patients who achieve sustained responses.