Meta-analysis Finds High Infection Burden With Teclistamab in Relapsed/Refractory Multiple Myeloma
A systematic review and meta-analysis found high infection rates with teclistamab in relapsed/refractory multiple myeloma. Five studies showed pooled infection rates of 56.5% for any grade and 27.6% for grade 3 or higher.
Teclistamab was associated with a substantial and cumulative infectious burden in patients with relapsed/refractory multiple myeloma, according to a systematic review and meta-analysis of clinical trial and real-world evidence. Five studies encompassing 714 patients were included, and the overall pooled incidence was 56.5% for any-grade infections and 27.6% for grade ≥3 infections.
Teclistamab, a B-cell maturation antigen (BCMA) × CD3 bispecific antibody, has shown remarkable efficacy in relapsed/refractory multiple myeloma. However, its mechanism leads to profound hypogammaglobulinemia, making infection a critical concern.
Subgroup analysis revealed a significantly higher risk in the clinical trial compared to real-world evidence. Any-grade infections were 76.4% in the clinical trial versus 45.4% in real-world cohorts, and grade ≥3 infections were 44.8% versus 22.8%, with p<0.01 for both comparisons.
Infection-related mortality was reported in all cohorts, ranging from 0.9% to 7.3%, with COVID-19 and opportunistic pathogens, for example, Pneumocystis jirovecii, being prevalent. Significant heterogeneity was driven by variations in follow-up duration and intravenous immunoglobulin prophylaxis rates, which ranged from 41.8% to 81.3%.
The analysis concluded that the lower infection rates in real-world evidence may reflect shorter follow-up and evolving prophylactic strategies. Standardized infection surveillance, including regular IgG monitoring and consideration of intravenous immunoglobulin replacement in patients with low IgG levels, may help optimize the safety of BCMA-directed bispecific therapies.