Recetved:14 March 2023Accepted:29 May 2023D0L:10.1111/bh.18909BJHaemHOW I APPROACHRecommendations on prevention of infections during chimericantigen receptor T-cell and bispecific antibody therapy in multiplemyelomaMeera Mohan Rajshekhar Chakraborty2 Susan Bal Anoma NelloreMuhamed Baljevics Anita D'Souza Peter G.Pappas Jesus G.BerdejaNatalie Callander?Luciano J.Costa3Division of Hematology/Oncology.MedicalCollege of Wisconsin,Milwaukee,Wisconsin,SummaryUSAChimeric antigen receptor T(CAR T)cell and bispecific antibody therapies haveMultiple Myeloma and Amyloidosis Program.shown unprecedented efficacy in heavily pretreated patients with multiple myelomaHerbert Irving Comprehensive Cancer Center,Columbia University,New York City,New(MM).However,their use is associated with a significant risk of severe infections,York,USAwhich can be attributed to various factors such as hypogammaglobulinemia,neu-Division of Hematology and Medicaltropenia,lymphopenia,T-cell exhaustion,cytokine-release syndrome and immune-Oncology.University of Alabama atBirmingham.Birmingham.Alabama USAeffector cell-associated neurotoxicity syndrome.As these therapies have beenDivision of Infectious Diseases,Untversityrecently approved by regulatory agencies,it is crucial to establish practical guidelinesof Alabama at Birmingham,Birmingham.for infection monitoring and prevention until robust data from prospective clinicalAlabama,USAtrials become available.To address this issue,a panel of experienced investigatorsSDivision of Hematology/Oncology.from the Academic Consortium to Overcome Multiple Myeloma through InnovativeVande rbilt-Ingram Cancer Center,Nashville,Trials(COMMIT)developed consensus recommendations for mitigating infectionsTennessee,USAassociated with CAR T-cell and bispecific antibody therapies in MM patients.Sarah Cannon Research Institute,Nashville,Tennessee,USADepartment of Medicine,Division ofKEYWORDSHematology and Oncologye,Universityofbispecific T-cell,chimeric antigen receptor T-cell,immunotherapy,infection,multiple myelomaWisconsin,Madison,Wisconsin,USACorrespondenceLuciano I.Costa,Division of Hematology andMedical Oncology,University of Alabama atBirmingham.Birmingham,AL,USA.Email:ljcosta@uabmc.eduINTRODUCTIONunprecedented efficacy of BsAb and CAR T-cell therapy inheavily pre-treated MMis encouraging,a signal for high riskT-cell redirecting immunotherapies have revolutionizedof severe infections as well as infection-related deaths havethe treatment of relapsed/refractory multiple myelomaemerged in clinical trials and real-world studies.25.6.13.17.1(MM),the three most promising targets thus far being B-The underlying mechanism leading to the increased riskcell maturation antigen (BMCA),-1G protein-coupledof infections appears to be multifactorial and includes pro-receptor,family C,group 5,member D(GPRC5D)12-14 andfound hypogammaglobulinemia due to plasma cell apla-Fc receptor-homologue 5(FcRH5).15.16 So far,the most ef-sia,cytopenias (neutropenia and lymphopenia)
