Dr. Joseph Mikhael:
Bispecific antibodies have had a prolific impact in the way we treat relapsed multiple myeloma. But we know that unfortunately they can increase a patient's risk of infections. How do we best manage those infections? Hi, everybody. Dr. Joseph Mikhael here, Chief Medical Officer of the International Myeloma Foundation. And welcome to our Myeloma Made Simple series where we take the complicated world of multiple myeloma and make it straightforward for you. Before I dive into today's episode, let me remind you that the IMF is here for you. We want to help you through this complicated journey. You can call us on the info line. You can visit us at myeloma.org. You can even use our chatbot, Myelo, to answer questions 24/7. And of course, we want you to employ this Myeloma Made Simple video series, where we take complicated topics and ideas and make them straightforward for patients and their partners so they can understand their treatments and understand their journey in myeloma.
Today's episode is Infection Management for Bispecific Antibodies. Bispecific antibodies have had a huge impact in how we treat relapsed and refractory multiple myeloma. Quick review. These are the drugs that use your own immune system to take down your myeloma by connecting the myeloma cell to your local T-cell or soldier cell. And they're brought together by this drug that's called bispecific as it hooks onto two things at the same time and triggers that immune system to destroy the multiple myeloma. But while it does that and it takes out the myeloma cells, it takes out some of your good plasma cells that help protect you from infection. And that's why infection management for bispecific antibodies is so important and why we want to make sense of it today and make it straightforward for you. Because typically, when a patient is treated with a bispecific antibody, we know they're at higher risk of infection, their plasma cells are lower, so they're not making that good immunoglobulin or antibodies for short. You know we use complicated words in medicine that patients don't understand. Immunoglobulin is basically just antibody.
But also it tends to reduce your blood cells, in particular, the white blood cells that help you fight off infection. So how do we manage infections in a patient who's on a bispecific antibody? Well, let's make it simple with four key steps. Number one, let's prevent the infection. This may be the most important aspect of managing infections with bispecific antibodies. We want to prevent them before they even happen. We do so by doing various things. We give patients certain drugs to prevent viral infections, to prevent a pretty rare but important infection called PJP. And sometimes we may even give general antibiotics to prevent certain kinds of infections when a patient's at high risk. All the while making sure that patients' immunizations are up-to-date. That strategy is the strategy to prevent infections.
Number two, we monitor for signs and symptoms of an infection. This is really a partnership between your healthcare team and you because you have to report these signs and symptoms to us. Are you having a fever? Are you having a cough? Are you short of breath? Anything that might speak of an infection, it's so important to speak to your healthcare team about it so they can determine if there really is an infection there and if it needs to be treated. Number three, we replace that missing immunoglobulin or antibody. We know that those antibody levels are typically low, in fact, they're pretty much low in every patient, so we replace it with something called IVIG, intravenous immunoglobulin. That's just the antibodies that you're missing to help prevent other infections.
And then lastly, number four, in some patients, and now in almost all patients, we reduce the frequency of the bispecific antibody given. When these drugs were first given, we would always give them every single week. But we've learned over time, especially as patients respond, that we can reduce the frequency of it. And that has led to a reduction in infections. So putting this all together, preventing infections, monitoring for signs and symptoms of infections, replacing IVIG, and reducing the frequency of the bispecific antibodies, we can dramatically reduce a patient's risk of infections while they're being treated.
I hope this video was helpful to you as we think about infection management and bispecific antibodies. It's part of a whole series of Myeloma Made Simple videos that we've created to help you in your journey through multiple myeloma. As you learn and understand the complexity of myeloma in a way that you can understand and convey to your team and convey to your family, we know this will facilitate your journey through multiple myeloma.
