T cell engagers (TCE) such as chimeric antigen receptor (CAR) T cell therapy and bispecific antibodies (BiAbs) for the treatment of multiple myeloma (MM) have significantly improved clinical outcomes, but have also raised awareness for ensuing post-treatment secondary immunodeficiency and hypogammaglobulinemia (HG). As patients with MM live longer, recurrent infections become a significant component of therapy-associated morbidity and mortality. Treatment of HG with immunoglobulin G replacement therapy (IgG-RT) has been a mainstay of the primary immunodeficiency (PI) world, and extrapolation to MM has recently started to show promising clinical outcomes. However, IgG-RT initiation, dosing, route, timing, monitoring, and management in MM has not been standardized in the setting of TCE. Progress in MM treatment will involve greater recognition and screening of underlying secondary immunodeficiency, identification of risk-stratification markers, optimizing IgG-RT management, and implementing other approaches to decrease the risk of infection. In this review, we summarize infection risk, risk of HG, and management strategies for IgG-RT in patients with relapsed MM after TCE.
用于治疗多发性骨髓瘤的T细胞衔接器（如嵌合抗原受体T细胞疗法和双特异性抗体）已显著改善临床疗效，但也使人们更加关注治疗后可能继发的免疫缺陷及低丙种球蛋白血症。随着多发性骨髓瘤患者生存期延长，反复感染已成为治疗相关发病率和死亡率的重要组成部分。免疫球蛋白G替代疗法一直是原发性免疫缺陷领域的核心治疗手段，近期将其推广应用于多发性骨髓瘤也开始展现出良好的临床前景。然而在T细胞衔接器治疗背景下，多发性骨髓瘤患者的免疫球蛋白G替代疗法的启动时机、剂量选择、给药途径、治疗周期、监测指标及管理方案尚未形成标准化规范。多发性骨髓瘤治疗的进步将需要加强对潜在继发性免疫缺陷的识别与筛查，确立风险分层标志物，优化免疫球蛋白G替代治疗管理，并实施其他降低感染风险的策略。本文综述了T细胞衔接器治疗后复发多发性骨髓瘤患者的感染风险、低丙种球蛋白血症风险及免疫球蛋白G替代疗法的管理策略。
肿瘤(癌症)患者之家