Infection prevention and management in patients with multiple myeloma treated with bispecific antibodies: a case-based approach for routine clinical practice

Patients with multiple myeloma (MM) treated with bispecific antibodies (BsAbs) represent a particularly vulnerable population for infectious complications due to profound disease-related immune dysfunction, and treatment-related immunosuppression. In addition, BsAbs themselves induce sustained T-cell activation and prolonged immune modulation, which, while highly effective for disease control, are associated with a relevant and sometimes severe infectious burden. As these therapies move into earlier lines of treatment and are administered over extended periods, optimizing infection prevention and management strategies has become a critical component of routine clinical practice. In this review, we present a case-based approach to infection prevention and management in MM patients receiving BsAbs. The first case focuses on baseline risk assessment and prophylactic strategies prior to and after treatment initiation. The second case addresses the diagnostic and therapeutic approach to febrile episodes occurring during therapy, with emphasis on early recognition, risk stratification, and empiric antimicrobial treatment. The third case discusses the diagnosis and management of opportunistic infections, highlighting the importance of tailored diagnostic work-up and pathogen-directed therapy in this highly immunocompromised setting. Through these clinical scenarios, we aim to provide a practical framework for implementing individualized infection prevention and management strategies in this rapidly expanding patient population within the evolving therapeutic landscape of MM.