Imagine a world where groundbreaking treatments offer new hope to patients battling advanced multiple myeloma, only to uncover a hidden danger lurking in the shadows: a heightened risk of life-threatening infections. This is the paradox of modern cancer therapy, where innovation and risk walk hand in hand. But here's where it gets even more complex—while CAR-T and bispecific antibody (BsAb) therapies are transforming the landscape of multiple myeloma treatment, they also bring unique challenges that demand our attention.
Chimeric Antigen Receptor (CAR) T-cell and bispecific antibody therapies have emerged as game-changers, providing patients with durable responses and renewed optimism in managing this aggressive disease. Yet, these advancements come with a significant trade-off: an increased susceptibility to infections and immune dysregulation. This delicate balance between breakthrough treatment and potential complications has clinicians and pharmacists navigating uncharted territory, striving to maximize benefits while minimizing risks.
And this is the part most people miss: Data unveiled at IDWeek 2025 shed light on the critical need for tailored infection prevention strategies and vigilant monitoring. A comprehensive analysis of the FDA Adverse Event Reporting System (FAERS) database compared infection rates and immune-related complications in patients treated with CAR-T therapies (Ciltacabtagene and Idecabtagene) and BsAb therapies (Teclistamab, Talquetamab, and Elranatanab). The findings were eye-opening.
The study revealed that while CAR-T recipients experienced an overall infection and immune dysregulation rate of 14.4%, BsAb-treated patients faced a significantly higher rate of 32.2% (P < .01). Interestingly, the types of infections differed between the two groups. CAR-T patients were more prone to hypogammaglobulinemia (1.31%) and fungal infections (1.20%), whereas BsAb patients frequently encountered cytomegalovirus infections (1.79%) and hypogammaglobulinemia (1.58%). These disparities underscore the distinct immune risk profiles associated with each therapy.
Here’s where it gets controversial: Infections coupled with immune complications like Cytokine Release Syndrome (CRS), Immune-Effector Cell-Associated Neurotoxicity Syndrome (ICANS), or Immune-Effector Cell-Associated Hemophagocytic Lymphohistiocytosis (IECHLH) were more prevalent in CAR-T recipients (20.0% vs 6.1%, P < .01). This raises a thought-provoking question: Are the risks of immune-related complications in CAR-T therapy outweighing its benefits? Or is this simply a challenge we must learn to manage more effectively?
The study’s forest plot vividly illustrated the heightened infection risk in CAR-T patients when immune dysregulation occurs, emphasizing the need for proactive management. For pharmacists, this translates into a pivotal role in guiding antimicrobial selection, adjusting doses for immunocompromised patients, and monitoring for early signs of infection or immune-mediated complications.
As these therapies become more widespread, the call for interdisciplinary collaboration grows louder. Hematologists, infectious disease specialists, and pharmacists must unite to develop consensus guidelines for infection prevention and management. Without this, the full potential of CAR-T and BsAb therapies may remain unrealized.
In essence, while these therapies are redefining multiple myeloma treatment, infections and immune-related complications remain formidable hurdles. Proactive strategies, including risk assessment, vigilant monitoring, and tailored prophylaxis, are non-negotiable. But here’s the bigger question: How can we strike the perfect balance between innovation and safety? Share your thoughts in the comments—do you think the benefits of these therapies justify the risks, or is there more we can do to mitigate them?
References:
Thiruvadi V, Mahadevan A, Asif S, Francisco D. (P-2165) Comparison of Incidence Reporting and Outcomes of Infections in Chimeric Antigen Receptor T (CART) Cell Therapy and Bispecific Antibodies (BsAb) Therapy for Multiple Myeloma: A Retrospective Pharmacovigilance Study. Presented at: IDWeek 2025. October 19-22, 2025. Atlanta, Georgia. Abstract P-2165.
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