Cytomegalovirus Reactivation in Myeloma Patients on Teclistamab | Francesca Cottini, MD | #ASH24

Hi, this is Francesca Cottini. I'm an assistant professor in the division of hematology at the Ohio State University. And I focus on multiple myeloma. Today I'm going to talk a little bit about our new data on the rate, prevalence and risk of CMV activation after treatment with bispecific antibodies such as teclistamab. Teclistamab is one of the newest bispecific antibodies approved for the treatment of patients with multiple myeloma after at least four lines of prior therapy. It targets BCMA. And it has shown very good overall response rate for our patient with relapsed refractory disease. More and more we use this medication. We have seen that, it increases the risk of any type of infection, especially upper respiratory tract infection, viral infection and pneumonias. And for that reason, most of the patients are receiving some type of like antimicrobial prophylaxis. Usually they take antiviral medication to prevent the risk of shingles or herpes infection. And, they also take something called bactrim, for instance, to prevent pjp pneumonias. What we have seen is that CMV, which is a very common virus, that most of the people get exposed when they're young, when they're kids, can also reactivate. This is a type of, opportunistic infection. And we look at our patient really with the teclistamab. And, we were checking CMV viral load because CMV can be latent in your body and then can reactivate and go through the blood and to different organs causing symptoms and signs. And we saw that looking at 23 patient like consequences patient, half of them had some type of CMV reactivation. And when the CMV PCR level, the CMV the anemia in the blood is very high, it can cause some type of symptoms, can cause abnormal liver function, can lower your platelets. Your white count can also go to different organs and cause, for instance, diarrhea, something called CMV colitis or can affect the lungs. CMV reactivation is very common, especially in patient posts. allogeneic stem cell transplant and usually if the levels are high as the one that we saw in some of the patient, you require some type of treatment. Our patient with CMV, the anemia reactivation had symptoms had, colitis, one of them and we were able to treat them with some specific antiviral therapy called acyclovir. And, all of these patients were able to remain on therapy, will teclistamab, and still have, ongoing response. We also saw that, patients who had the CMV, anemia also were more prone to other type of infection, viral infection, bacterial infection and fungal infection. And their duration of response to the teclistamab tend to be a little bit shorter, even though our Kasese was like only 23 patients. So overall, I think that our data start to show that also CMV reactivate can occur with bio specific antibodies. And we are actively, monitoring every patient that received teclistamab. To make sure they don't reactivate their CMV. And in case they do, we can treat proactively. Future studies are really try to see how much this is impacting, the prognosis, the function and the effectiveness of the teclistamab. And we are working with other groups from like the Big Ten institution to kind of enlarge our because this weeks and have a bigger number of patients involved.