Bispecific antibodies (BsAbs) have expanded therapeutic options for patients with relapsed/refractory B-cell lymphomas, yet their use has introduced a distinct spectrum of infectious complications that remain poorly characterized. In the largest cohort study to date, we evaluated 122 patients treated with CD3×CD20 BsAbs between 2016 and 2024 to assess the incidence, characteristics, and risk factors of infections. Over a median follow-up of 25.0 months, a total of 143 infectious episodes were identified, 61.5% of which were grade ≥3. The median time to infection onset was 6.5 months, with bacterial infections occurring earliest (4.9 months), followed by fungal (7.0 months) and viral infections (8.1 months). Among microbiologically defined infections, viral infections were the most common (62.1%), with SARS-CoV-2 and cytomegalovirus being the leading causes. Of the 122 patients, 74 (60.7%) experienced at least one infectious episode, and 45 (36.9%) had grade ≥3 infections. The cumulative incidence of infection steadily increased over 24 months, reaching 75.6% at 24 months. The cumulative incidence of cytomegalovirus infection steadily increased over the first 12 months. Neutropenia (ANC 1,000/μL) and hypogammaglobulinemia (IgG 400 mg/dL) were independent risk factors for all-grade infection, while hypogammaglobulinemia was the sole independent risk factor for grade 3-5 infection. Early corticosteroid use was not associated with increased infection risk. In summary, this study provides a temporal map of infection dynamics and highlights underrecognized complications, such as CMV reactivation. Risk-adapted therapeutic approaches and refined supportive care strategies are warranted for patients with B-cell lymphomas treated with BsAbs.
Kim et al. (Thu,) studied this question.