Work

Infections in patients with lymphoma treated with bispecific antibodies: a systematic review and meta-analysis

Year: 2024

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Bispecific antibodies (BsAbs) have demonstrated efficacy in newly diagnosed and relapsed/refractory (R/R) lymphomas.BsAbs form immune synapses between effector cells (T cells) and target cell surface markers; typically, CD19 and CD20 in B-cell lymphomas.BsAb use in myeloma has raised concerns about increased infection risk 1 ; less is known about infection rates after BsAb treatment for lymphoma.Three CD20-directed BsAbs are now available for lymphoma as standard of care, and approvals across jurisdictions such as the United States, Canada, and Europe are evolving rapidly. 2 US Food and Drug Administration (FDA) approvals were largely based on small phase 1b/2 studies in heterogenous populations with different dosing schedules, treatment durations, and supportive care protocols.Despite regulatory approvals, there are no guidelines for anti-infective prophylaxis and an incomplete understanding of the rates, timing, and types of infections experienced.Therefore, a systematic review and meta-analysis were undertaken to better characterize infection risks associated with BsAb therapy.We conducted a PRISMA systematic review and meta-analysis (PROSPERO: CRD42023433207).3 The search strategy is detailed in the supplemental appendix.Studies reporting infection outcomes after CD20-directed BsAb therapy for the treatment of B-cell lymphoma in adult patients were included.Study identification, data extraction, and bias assessment 4 were performed independently by 2 authors (G.K.R. and M.M.).The primary outcome was the proportion of patients with lymphoma receiving BsAb treatment in a clinical trial who experienced ≥1 infection of any grade.Secondary outcomes included the rate of severe (grade ≥3) and fatal (grade 5) infections.Subgroup analyses of severe infections were performed according to aggressive vs indolent lymphomas (defined by the World Health Organization diagnostic criteria), 5 monotherapy vs combination therapy, newly diagnosed vs R/R disease, and bispecific agent.Observational studies were described separately.Meta-analysis of proportions estimated the pooled infection incidence.Cochran Q test examined heterogeneity (I 2 ).Secondary outcomes and subgroup analyses were performed using random effects models (Mantel-Haenszel).Institutional review board approval was not sought because this study did not constitute human participant research.

Source: Blood Advances

DOI: 10.1182/bloodadvances.2024012916