IVIG Therapy Reduced Infections by 67% in Patients With Multiple Myeloma

Treatment with intravenous Immunoglobulin (IVIG) following infection from BCMA therapies yielded a 67% decrease in infections in patients with multiple myeloma (MM), highlighting its promising clinical benefit. The data were presented at the 2025 International Myeloma Society Annual Meeting in Toronto, Canada.

BCMA bispecific antibody (BsAbs) therapies revolutionized treatment for patients with MM. BCMA is a highly expressed protein found in about 90% of all patients with MM, making is a significant therapeutic target. However, BsAbs, among other treatment options, are associated with increased risk of infections due to lowered humoral immunity. IVIG is the recommended prophylactic treatment for infections.^1,2

To better elucidate the benefit of IVIG for patients with MM, researchers performed a retrospective analysis of de-identified electronic health records from Epic Cosmos, covering over 1700 hospitals and 40,000 clinics in the United States. Their assessment included patients with MM (n = 1646; > 18 years of age) who received more than 2 doses of elranatamab (n = 155) or teclistamab (n = 1491) who were followed from first to last administration.²

The median age at the time of initiation of treatment was 70 years (IQR, 63–76). Of the population, 881 (53.5%) were male and 1042 (63.3%) identified as White. The majority of patients lived in urban areas (n =1402, 86%). Median time from diagnosis to treatment initiation was 4.7 years (IQR, 2.3–7.5).²

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes served as the basis for identifying infection events. Episodes were counted as separate if they were represented by different ICD codes or occurred more than 56 days apart. Analyses included calculating the proportion of patients who experienced each toxicity type, determining toxicity incidence rates, and measuring time to first toxicity. Infection rates before and after IVIG treatment were evaluated using a paired t-test.²

The researchers reported that 30% of patients had at least 1 infection at a rate of 0.06 (standard deviation [SD], 0.27) episode/patient-month with a median time to infection of 0.06 (standard deviation [SD], 0.27) episode/patient-month of 2 months (IQR, 0.7–5.1). The most common infection was bacterial sepsis (n = 200, 12.2%), followed by febrile neutropenia (n = 126, 7.7%) and viral pneumonia (n = 89, 5.4%). Patients treated with teclistamab showed a higher risk of infection (n = 458, 30.7%) compared with patients treated with elranatamab (n = 35, 22.6%; P = 0.03).²

Treatment with IVIG led to notable results. A little over half of patients (50.2%) received IVIG during BsAb treatment. Among these patients, the infection rate decreased from 0.27 episodes per patient-month (SD, 0.27) before IVIG to 0.03 episodes per patient-month (SD, 0.15) after IVIG (P < .001).²

“In this largest nationwide cohort of MM patients treated with anti-BCMA BsAb, only half of the patients received IVIG and use of IVIG was associated with a 67% decrease in infections,” the authors concluded in their abstract. “More awareness is needed to expand the use of IVIG to prevent infections in patients receiving BsAbs and prospective studies would be crucial to establish its optimal dosing schedules.”²

REFERENCES

1. Gerlach A. Real-world outcomes show efficacy, safety of ciltacabtagene autoleucel in relapsed, refractory multiple myeloma. Pharmacy Times. January 6, 2025. Accessed September 17, 2025. https://www.pharmacytimes.com/view/real-world-outcomes-show-efficacy-safety-of-ciltacabtagene-autoleucel-in-relapsed-refractory-multiple-myeloma

2. Tan C, Zhang M, Cho J, et al. Risk of infections after bispecific antibodies targeting anti-B-cell maturation antigen (BCMA) in multiple myeloma-intravenous immunoglobulin (IVIG) significantly lowers the risk of infection. 2025 International Myeloma Society Annual Meeting. Toronto, Canada. Abstract PA-529