IVIG and Preventing Infections in Myeloma Patients on Teclistamab | Heloise Cheruvalath | #ASH24

Hi, I'm Heloise Shruveloth. I'm a third-year medical student at the Medical College of Wisconsin. I'm here to talk about my research with many other people from multiple institutions having to do with supplementing intravenous immunoglobulin to reduce infection risk in people who are getting BCMA directed by specific antibody therapy for multiple myeloma. Basically, BCMA or B-cell maturation antigen directed by specific antibody therapy is unprecedentedly effective in patients who have relapsed or refractory multiple myeloma. One major problem with it is the increased risk of infection that's present in almost all patients. They have profoundly low levels of IgG, which makes it difficult to fight off infection. So very basically, by specific antibodies try and attach to two different cells or proteins or whatever targets, in this case the cancer cell and then also the B-cells, and bring them together. So in this case, you're trying to kill the cancer essentially by bringing the cells that kill the cancer into contact with the cancer itself. So in essence, what we're trying to do is figure out a way to try and reduce this infection risk that comes with using this therapy. Our research has actually been very interesting in showing that primary IVIG prophylaxis or giving intravenous immunoglobulin within about 39 days is how we ended up doing it. That's our institutional practice within the first two cycles of our therapy. We found that that actually increases infection-free survival, progression-free survival, and overall survival of our patients. So we're pretty excited about that. IVIG is basically intravenous, so you're injecting the immunoglobulins or kind of the antibodies that your body would normally be making by itself, but finds it difficult to do so when you're treating multiple myeloma as a bone marrow cancer. You're kind of depleting the cells that make the antibodies that fight off whatever infections you may be getting. So in our patients, we were seeing mostly upper respiratory infections. COVID was about 11% of those, but bacterial, viral, and some fungal infections were what we were dealing with. So out of our patients, most of them actually ended up being hospitalized inpatient for infections while we were treating them. And this is a very well-known problem with multiple myeloma treatment. And so at our institution and multiple other ones, we tried using IVIG to kind of combat this infection risk. So for some numbers, I have them here. Basically, patients who got primary IVIG prophylaxis had prolonged median progression-free survival, so a longer amount of time without any progression of their disease. People with primary IVIG was 15 months compared to eight months without. And then for overall survival, survival of the patients, primary IVIG prophylaxis gave an 18-month longer median survival. Basically, this could be something that will influence how easy it is for patients to get IVIG, because as of now, insurance doesn't always cover this. So if we were able to start within, let's say the takeaways that you should start IVIG within 30 days, because our mean time to starting IVIG was about 39 days. If we were able to do that, we might be able to reduce some of the risk of this infection that's causing serious morbidity and mortality in the patients that are getting this treatment, which is very effective but has this unfortunate side effect for multiple myeloma. So we hope that maybe seeing this data could inspire more research and easier availability, I guess, of IVIG for patients who could really benefit from it.