IgG replacement in multiple myeloma

• Published in: Blood cancer journal (New York) Vol. 14; no. 1; pp. 124 - 9
• Main Authors: Wonnaparhown, Alex, Hilal, Talal, Squire, Jacqueline, Freeman, Catherine, Fonseca, Rafael
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 25-07-2024; Springer Nature B.V; Nature Publishing Group
• Subjects: 692/699/249/1570; 692/699/67/1990/804; Agammaglobulinemia - immunology; Agammaglobulinemia - therapy; Biomedical and Life Sciences; Biomedicine; Cancer Research; Clinical outcomes; Hematology; Humans; Immune system; Immunoglobulin G - immunology; Immunoglobulin G - therapeutic use; Multiple myeloma; Multiple Myeloma - immunology; Multiple Myeloma - therapy; Oncology; Review Article
• ISSN: 2044-5385; 2044-5385
• DOI: 10.1038/s41408-024-01107-6

T cell engagers (TCE) such as chimeric antigen receptor (CAR) T cell therapy and bispecific antibodies (BiAbs) for the treatment of multiple myeloma (MM) have significantly improved clinical outcomes, but have also raised awareness for ensuing post-treatment secondary immunodeficiency and hypogammaglobulinemia (HG). As patients with MM live longer, recurrent infections become a significant component of therapy-associated morbidity and mortality. Treatment of HG with immunoglobulin G replacement therapy (IgG-RT) has been a mainstay of the primary immunodeficiency (PI) world, and extrapolation to MM has recently started to show promising clinical outcomes. However, IgG-RT initiation, dosing, route, timing, monitoring, and management in MM has not been standardized in the setting of TCE. Progress in MM treatment will involve greater recognition and screening of underlying secondary immunodeficiency, identification of risk-stratification markers, optimizing IgG-RT management, and implementing other approaches to decrease the risk of infection. In this review, we summarize infection risk, risk of HG, and management strategies for IgG-RT in patients with relapsed MM after TCE.