Journal: Blood advances
This cohort study analyzed infectious complications in 109 patients with relapsed/refractory B‑cell lymphomas treated with CD20×CD3 bispecific antibodies between 2016–2024.
Key findings:
- Follow-up and burden
- Median follow-up: 28.4 months.
- Total infections: 134 infectious episodes documented; 61.2% were grade ≥3.
- Patients affected: 62.4% of patients had at least one infection; 37.6% had grade 3–5 infections.
- Cumulative incidence: any infection reached 76.4% at 24 months.
- Timing and types of infections
- Median time to first infection: 6.6 months.
- Onset by pathogen type:
- Bacterial: 5.9 months (earliest).
- Fungal: 7.0 months.
- Viral: 8.3 months.
- Etiology: among microbiologically defined infections, viral etiologies were most common (61.1%), with SARS‑CoV‑2 and CMV predominant.
- CMV reactivation: CMV infections accumulated steadily over the first 12 months, highlighting clinically relevant reactivation risk.
- Risk factors
- All‑grade infections: neutropenia (ANC <1.0 × 10⁹/L) and hypogammaglobulinemia (IgG <400 mg/dL) were independent risk factors.
- Severe infections (grade 3–5): hypogammaglobulinemia was the only independent predictor.
- Corticosteroids: early corticosteroid use did not increase infection risk.
- Clinical implications
- Infection burden: CD20×CD3 bispecific antibodies are associated with frequent and often severe infections, particularly viral and CMV reactivation.
- Monitoring: the data provide a temporal pattern of infections that can inform monitoring strategies.
- Supportive care: findings support risk‑adapted prophylaxis and more aggressive supportive care (e.g., immunoglobulin replacement consideration in marked hypogammaglobulinemia, and structured viral surveillance, especially for CMV) in patients receiving these agents.