Dr Joshua Richter, associate professor of medicine at Tisch Cancer Institute, discusses his presentation from ESMO 2022 regarding the effects of immune therapies on infection in patients with multiple myeloma.

Transcript

My name is Dr Joshua Richter. I'm an Associate Professor of Medicine at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai in New York, and the Director of Myeloma, The Blavatnik Family – Chelsea Medical Center in New York.

I'm going to talk to you today about a presentation we had at ESMO 2022. It was an abstract entitled, “The Burden of Infection in Patients with Multiple Myeloma and Secondary Immunodeficiencies: A Retrospective Cohort Study.” As therapies have improved in myeloma, we recognize that the type of treatments that we need to suppress these malignant plasma cells also has the potential to lead to infectious complications through suppression of normal plasma cells and other immune effector cells, and ultimately, infection burden is becoming an increasingly important aspect that we need to monitor for our patients, both in terms of morbidity and mortality. We undertook this retrospective cohort study looking at the Optum Humedica Electronic Medical database for patients between 2015 and March of 2020.

We specifically took this period just before the COVID era because we know that the COVID pandemic certainly has thrown a lot of this data into chaos, and we want to get a pure sample separate from the COVID pandemic to analyze what the direct effect of our immune therapies have been on our multiple myeloma patients. Ultimately, we looked at thousands of patients in the database with multiple myeloma, both those that had secondary immunodeficiency and those that did not. We excluded patients with primary immune deficiency, and we defined secondary immune deficiency as people who had a significantly low IgG level, lower than 500 milligrams defined by the index date. Ultimately, we compared those who fit the criteria for having secondary immune deficiency in multiple myeloma vs those that did not have secondary immune deficiency in myeloma. Ultimately, in the SID group, we had 870 patients and the myeloma patients without SID, we had 3,768 patients.

When we compared these matched cohorts, we found that patients with SID had a higher number of infections, a higher number of severe bacterial infections, a higher number of hospitalizations, and an increased length of stay in those hospitalizations. Ultimately, when we looked at the total group, we found that there was a substantially higher burden of infection and health care resource utilization in patients with secondary immune deficiency and myeloma compared with those who did not. Ultimately, this translated to a lower overall survival with patients with SID compared to those who did not.

Ultimately, we need to better understand this as our current modality of therapies is evolving, and we've moved through three different epochs of therapy for myeloma from the classical chemotherapy world to the novel agent world, and now in the era of T-cell redirection therapy, our ability to control myeloma long term has greatly increased. However, as a result, our patients are having significantly more complications related to immune suppression and ultimately covered under the umbrella of secondary immune deficiency. We're trying to evaluate better characteristics of understanding who truly has SID that needs to be managed, either with immunoglobulin replacement therapy, prophylactic anti-infectives, or both. So the goal is ultimately, as on one hand, we continue to improve efficacy, we are seeking to improve tolerability through better management and identification of patients with secondary immune deficiency in multiple myeloma.

Disclosures: Dr Richter has served on speakers’ bureaus for BMS and Janssen; and has received consulting fees/has served on advisory boards for BMS, Adaptive Biotechnologies, AstraZeneca, Celgene, Janssen, Karyopharm, Oncopeptides, Sanofi, Takeda, Secura Bio and X4 Pharmaceuticals.”