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Bispecific antibodies (BsAbs) are an effective treatment used in relapsed or refractory multiple myeloma. Despite a well-tolerated safety profile, infectious events appear to be frequent in clinical trials. Real-world data on epidemiology, characteristics, risk factors, and outcomes of infections in patients treated with BsAb are still needed. A retrospective, multicentre study in BsAb-treated patients with multiple myeloma was performed in 14 French centres from December 2020 to February 2023. The primary objective was to describe the incidence of infections that required hospitalization, specific treatment, or adaptation in BsAb administration. Among 229 patients with multiple myeloma treated with BsAb, 153 (67%) received teclistamab, 47 (20%) received elranatamab, and 29 (13%) talquetamab. We reported a total of 234 infections, including 123 (53%) of grade of ≥3. Predominant infections affected the respiratory tract (n = 116, 50%) followed by bacteraemias (n = 36, 15%). The hospitalization rate was 56% (n = 131), and 20 (9%) infections resulted in death. Global cumulative incidence of the first infection was 70% in all patients, 73% in patients treated with B-cell maturation antigen-targeting, and 51% with GPRC5D-targeting BsAb. In univariate analyses, corticosteroids for cytokine release syndrome (CRS)/immune effector cell-associated neurotoxicity syndrome (ICANS) were associated with a higher risk of first infection (HR = 2.13; 95% CI, 1.38–3.28), whereas GPRC5D-targeting BsAb and anti-bacterial prophylaxis were associated with a lower risk (HR = 0.53; 95% CI, 0.3–0.94 and HR = 0.65; 95% CI, 0.46–0.9). Fine and Gray multivariate model found that only corticosteroids for CRS/ICANS were correlated with a higher risk of first infection (HR = 2.01; 95% CI, 1.27–3.19). The implementation of preventive measures that aim to mitigate the risk of infection under BsAb is pivotal, notably in patients who received corticosteroids for CRS/ICANS. [ABSTRACT FROM AUTHOR]

The patients in our study were nonetheless older, had worse performance status, a poor Charlson Comorbidity Index and were for most of them refractory to their previous treatment line thus explaining part of the lower ORR and CR rates in our cohort. Efficacy Patients received a median of 3.2 cycles (1-19 cycles), Figure 1A. One patient received whole brain radiotherapy consolidation after obtaining a partial response under treatment. All patients had relapsed (n = 6) or refractory (n = 16) disease, after a median of two lines of therapy (range, 1-3). [Extracted from the article]

• Antibiotics can be discontinued in neutropenic haematology patients. • Discontinuation of antibiotics in this population is safe and results in significant antibiotic sparing. • This strategy does not lead to severe infectious episodes or excessive mortality. • Overall, 287 antibiotics days were spared; this represents 49% of our consumption. Antibiotics for febrile neutropenia (FN) in acute myeloid leukaemia (AML) patients undergoing intensive chemotherapy are usually maintained until neutropenia resolution, because of the risk of uncontrolled sepsis in this vulnerable population. This leads to unnecessarily prolonged antimicrobial therapy. Based on ECIL-4 recommendations, we modified our management strategy and discontinued antibiotics after a pre-established duration in patients treated for a first episode of FN between August 2014 and October 2017. Antibiotics were stopped during 62 FN episodes, and maintained in the control group (n = 13). Median age of patients was 54 years. A total of 39 (63%) patients received induction and 23 (37%) consolidation chemotherapy; 36 (58%) patients had fever of unknown origin. Median neutropenia length was 26 days (IQR 24–30). Antibiotics were started at day 9 (IQR 5–13). Most patients received piperacillin-tazobactam (56%) or cefepime (32%). Antimicrobial therapy was longer in the control group than in the policy compliant group, 10 (IQR 7–16) vs. 19 days (IQR 15–23), P = 0.0001. After antibiotics discontinuation, 20% patients experienced fever recurrence, within 5.5 days (IQR 3–7.5). None of these febrile episodes were severe and 80% patients remained afebrile, with neutrophil recovery occurring within 5 days (IQR 2–8.5). Overall, 287 antibiotics days were spared; this represents 49% of all days with antibiotics. No patient had died at day 30 from intervention; six died during late follow-up, two from graft-versus-host disease and four from relapsed or refractory leukaemia. Discontinuing antibiotics in neutropenic AML patients treated for a first episode of FN is safe, and results in significant antibiotic sparing. [ABSTRACT FROM AUTHOR]

Un patient est hospitalisé au CHU de Lille dans le cadre d'une maladie de Hodgkin. Il est allogreffé le 14/06/18 et transfusé de 5 CGR et de 4 MCPS entre le 20/06 et le 04/07/18. Début août, il présente un ictère et des perturbations du bilan hépatique justifiant la réalisation de PCR virales (...). Les résultats revenant négatifs, le patient est testé pour le VHE en seconde intention. La PCR VHE s'avère positive le 31/08/18 (PCR VHE pré-greffe du 15/05/18 négative). La PCR VHE réalisée sur le prélèvement pré-greffe du donneur de CSP est également négative. L'enquête est menée sur les 26 cryotubes correspondant aux PSL transfusés (sérothèque donneurs). Elle met en évidence un don positif (MCP transfusé le 23/06/18). L'enquête porte sur la recherche de facteurs de risque chez le donneur en cause et le suivi des produits satellites issus du don (un plasma envoyé au LFB le 05/07/18 et un CGR transfusé le 05/07/18 dans un autre établissement de la région). Nous proposons d'exposer les éléments de cette enquête. [ABSTRACT FROM AUTHOR]