Infection Prevention Strategies and the Role of IVIg With Bispecific Therapy

Drs Paul Richardson and Hans Lee focus on practical infection mitigation strategies for patients receiving BCMA-directed bispecific antibodies, with particular emphasis on the proactive use of intravenous immunoglobulin. The faculty discuss how early approaches that reserved IVIg for patients with recurrent infections or low IgG levels have evolved toward routine primary prophylaxis. Dr Richardson shares real-world dosing practices, including monthly IVIg administration regardless of baseline IgG levels, while Dr Lee reinforces that this shift has been associated with meaningful reductions in serious infection rates observed in both clinical trials and real-world studies. The discussion also highlights emerging evidence suggesting that maintaining higher IgG thresholds may be associated with improved clinical outcomes across multiple immunotherapeutic platforms, including CAR T-cell therapy, bispecific antibodies, and CD38-directed monoclonal antibodies. Together, the speakers underscore the importance of adapting infection prevention strategies to the realities of modern immunotherapy, emphasizing IVIg as a foundational component of safe and effective long-term bispecific treatment in relapsed or refractory multiple myeloma.