Early IVIG Use Associated With Reduced Infections and Improved Survival in Patients Receiving Talquetamab for Multiple Myeloma

For patients with relapsed or refractory multiple myeloma (RRMM), bispecific antibodies have rapidly become an important treatment option that provides meaningful responses in heavily pretreated populations. Despite this, these therapies may also result in profound immune dysfunction, resulting in patients becoming vulnerable to serious infections that contribute significantly to morbidity and mortality. In emerging real-world data presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting, it is indicated that early administration of intravenous immunoglobulin (IVIG) has the potential to substantially reduce infection risk and improve survival among patients treated with talquetamab (Talvey; Janssen Pharmaceuticals), a GPRC5D-directed bispecific antibody.¹

Infection Remains a Major Challenge With Bispecific Antibodies

The treatment landscape for RRMM has transformed due to the emergence of bispecific T-cell-engaging (BiTE) antibodies. Through redirecting T cells toward malignant plasma cells, these agents can produce deep responses in patients who have exhausted multiple prior lines of therapy. Although, the immune disruption associated with bispecific therapies has raised growing concerns regarding infectious complications.¹

While talquetamab has generally proven to lower infection rates as opposed to anti-BCMA-directed bispecific antibodies, infections persist as a significant clinical concern. Prior data has supported the use of prophylactic IVIG in patients receiving anti-BCMA therapies, but limited evidence has been available regarding the role of IVIG in patients treated with talquetamab.¹

Evaluating the Impact of Early IVIG Administration

The data conducted a retrospective multicenter cohort study using data from the TriNetX Research Network in order to evaluate outcomes amongst adults who had multiple myeloma treated with talquetamab.¹

Patients who received IVIG within 4 weeks of talquetamab initiation were compared with those who did not receive IVIG during the same period. To minimize potential confounding, researchers performed propensity score matching that accounted for demographics, comorbidities, prior therapies, laboratory markers of disease severity, immunoglobulin levels, extramedullary disease, and plasma cell leukemia.¹

The primary end points included 1-year all-cause mortality and infection incidence, while secondary end points evaluated infection subtypes and intensive care unit admissions.¹

Early IVIG Reduced Infections and Mortality

Amongst 834 patients treated with talquetamab, 305 of those patients received IVIG within 4 weeks of treatment initiation. Following propensity score matching, 271 patients remained in each cohort with balanced baseline characteristics.¹

Early IVIG use was associated with a significant reduction in 1-year mortality in comparison with no early IVIG administration. The mortality rates were 14.8% among patients who received early IVIG versus 26.7% among those who did not (OR, 0.48; 95% CI, 0.31-0.74).¹

The data furthermore observed a significant reduction in infections of any type. Infection rates were 41.7% in the early IVIG group compared with 55.0% amongst patients who did not receive IVIG (OR, 0.59; 95% CI, 0.42-0.82).¹

The most significant reductions were noted in respiratory infections and bloodstream infections, suggesting that IVIG may provide meaningful protection against some of the most clinically consequential infectious complications associated with bispecific antibody therapy.¹

Survival Benefit Persisted After Multivariable Adjustment

Crucially, the survival benefit associated with IVIG remained significant after adjustment for potential confounding variables.¹

In multivariable Cox proportional hazards modeling, early IVIG administration was independently associated with a lower risk of death (HR, 0.52; 95% CI, 0.37-0.73).¹

The data also demonstrated a separate analysis comparing patients who received early IVIG with those who received no IVIG exposure during the first year of treatment. This analysis yielded similar findings, further supporting the robustness of the observed association between IVIG use and improved clinical outcomes.¹

Implications for Supportive Care in Multiple Myeloma

As routine multiple myeloma care increasingly integrates bispecific antibodies, the optimizing of supportive care strategies has emerged as a critical component of treatment success. While the primary focus has been on improving efficacy, preventing treatment-related complications may prove to be equally important for maximizing patient outcomes.

The data provided by this large real-world analysis indicate that early IVIG administration may represent a relatively simple intervention capable of reducing both infection risk and mortality among patients receiving talquetamab. While prospective validation is warranted, these results add to the growing body of evidence supporting proactive infection prevention strategies in patients treated with immune-directed therapies.¹

REFERENCES

1. O'Brien J, Nair M, Bitz N, et al. Early intravenous immunoglobulin use in multiple myeloma patients treated with talquetamab: Effect on risk of infections and mortality. Presented at: 2026 ASCO Annual Meeting; May 29-June 2, 2026; Chicago, IL. Abstract 7573.