The Long-Term Infection Risk: How Pharmacists Are Approaching Prophylaxis and Monitoring in Bispecific Myeloma Care

In this episode, 'The Long-Term Infection Risk: How Pharmacists Are Approaching Prophylaxis and Monitoring in Bispecific Myeloma Care,' the oncology pharmacists explore the following questions:

Infection is an increasingly important long-term concern for patients on bispecific therapy. How should pharmacists be thinking about prophylaxis and monitoring as therapy extends beyond initiation?

Where do options like IVIG fit into your response to infection, and what are the key considerations for using this approach?

The panelists examined why infection deserves significantly more clinical attention than it typically receives relative to CRS and neurotoxicity, particularly for patients on BCMA-targeting bispecific antibodies, emphasizing that while CRS is largely a step-up dosing concern, infection risk is a persistent and escalating risk that becomes the primary safety focus once patients transition into the maintenance phase of therapy. The discussion outlined a three-pronged prophylaxis framework being implemented at experienced centers, including universal herpes zoster prophylaxis with acyclovir or valacyclovir per package insert and NCCN guidance, PJP prophylaxis for all patients despite the absence of current guideline recommendations, and primary IVIG prophylaxis initiated for all patients on BCMA-directed bispecific antibodies regardless of measured IgG levels, typically starting mid-first cycle or immediately after step-up dosing is complete. The panelists also highlighted two particularly important operational considerations around infection prophylaxis: the growing challenge of payer-driven formulary fragmentation across IVIG preparations that is forcing institutions to navigate an expanding number of products without clinical differentiation, and the critical importance of structured care transition reviews by cell therapy pharmacists to identify and close prophylaxis gaps for patients arriving from other institutions who may have missed antimicrobial or IVIG coverage during the handoff process.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'Patient Selection and Line-of-Therapy Navigation: Practical Insights for a Complex Myeloma Treatment Landscape,' features the panelists advancing their conversation on multiple myeloma and focusing on how clinicians are defining and navigating an increasingly crowded bispecific antibody landscape, the patient-specific and geography-specific factors that drive agent selection, and the real-world challenges of defining lines of therapy accurately in a field where definitions are evolving and payer coverage decisions are closely tied to documentation strategy.