Infection Prevention on T-Cell–Redirecting Therapies: IVIG, PJP Prophylaxis, and Insurance Strategies

This segment focuses on infection prevention and management in patients receiving T-cell–redirecting therapies such as bispecific antibodies. Faculty discuss strategies to mitigate the elevated infectious risk associated with prolonged immunosuppression and treatment-related hypogammaglobulinemia. Approaches such as IVIG replacement therapy, often initiated early and administered regularly, are reviewed alongside Pneumocystis jirovecii pneumonia (PJP) prophylaxis tailored to patient blood counts and medication tolerability, including options such as trimethoprim-sulfamethoxazole or pentamidine.

The panel also highlights the importance of maintaining up-to-date vaccinations, including influenza, pneumococcal, RSV, and COVID-19 vaccines, as well as maintaining a low threshold for temporarily holding bispecific therapy when symptoms of infection arise.

Practical considerations related to securing IVIG authorization in clinical practice are also discussed, including documentation of hypogammaglobulinemia and the use of ICD-10 coding to support coverage for patients at elevated risk of infection due to immunosuppression. Overall, the segment examines real-world strategies to reduce infection-related complications and treatment interruptions in patients receiving T-cell–redirecting therapies.