Infection Risks Complicate CAR-T and BsAb Therapies for Multiple Myeloma

Pharmacists must lead in proactive infection management as these transformative treatments redefine MM care

Apr. 11, 2026 at 4:14pm

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A ghostly, translucent X-ray photograph revealing the intricate internal structures of a medical device or biological component related to multiple myeloma treatment, conveying a sense of clinical precision and the delicate balance between the power of these therapies and the need to manage their immune-related complications.Cutting-edge multiple myeloma therapies offer remarkable disease control, but their success hinges on proactive infection management by pharmacists.Atlanta Today

Despite advancements in multiple myeloma (MM) treatment, infections remain a leading cause of non-relapse mortality in patients undergoing cutting-edge therapies like CAR-T and bispecific antibody (BsAb). While these therapies offer unprecedented disease control, they also introduce significant infection risks and immune-related complications that challenge even the most vigilant clinicians. A retrospective study found higher infection rates in BsAb patients versus CAR-T, with unique infection profiles for each therapy. Infections paired with immune complications were more prevalent in CAR-T recipients, underscoring their heightened vulnerability. Pharmacists must spearhead risk assessment, antimicrobial selection, and early detection to address this critical issue and realize the full potential of these transformative treatments.

Why it matters

Chimeric Antigen Receptor (CAR) T-cell and bispecific antibody (BsAb) therapies have revolutionized multiple myeloma (MM) treatment, but their success comes with a caveat - a heightened risk of infections and immune-related complications that can significantly impact patient outcomes. Addressing this challenge requires a multidisciplinary approach led by pharmacists to ensure proactive infection management and vigilant monitoring.

The details

Data from IDWeek 2025 revealed stark differences in infection incidence and immune complications between CAR-T and BsAb therapies for MM. A retrospective pharmacovigilance study using the FDA Adverse Event Reporting System (FAERS) database found a 14.4% infection rate in CAR-T recipients versus 32.2% in the BsAb group (P < .01). The types of infections also varied, with CAR-T patients more prone to hypogammaglobulinemia and fungal infections, while BsAb-treated patients frequently experienced cytomegalovirus infections and hypogammaglobulinemia. Infections paired with immune complications like Cytokine Release Syndrome (CRS), Immune-Effector Cell-Associated Neurotoxicity Syndrome (ICANS), or Immune-Effector Cell-Associated Hemophagocytic Lymphohistiocytosis (IECHLH) were more prevalent in CAR-T recipients (20.0% vs 6.1%, P < .01), underscoring their heightened vulnerability.

  • The data was presented at IDWeek 2025, held from October 19-22, 2025 in Atlanta, Georgia.

The players

Chimeric Antigen Receptor (CAR) T-cell therapies

Transformative treatments for multiple myeloma that have revolutionized the treatment landscape, offering durable responses and renewed hope, but also introducing significant infection risks and immune-related complications.

Bispecific antibody (BsAb) therapies

Emerging therapies for multiple myeloma that have also demonstrated remarkable anti-myeloma activity, but with a different profile of infection risks and immune complications compared to CAR-T therapies.

Pharmacists

Healthcare professionals who must lead in proactive infection risk assessment, antimicrobial selection, dosing adjustments, and early detection of infection or immune-mediated complications to address the critical challenges posed by these transformative therapies.

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What’s next

With the rapid expansion of CAR-T and BsAb therapies, there is an urgent need to develop consensus guidelines for infection prevention and management in this high-risk patient population. Interdisciplinary collaboration among hematologists, infectious disease specialists, and pharmacists is imperative to ensure the full therapeutic potential of these transformative treatments is realized.

The takeaway

While CAR-T and BsAb therapies offer unprecedented hope for multiple myeloma patients, infections and immune complications remain formidable challenges that require a multidisciplinary approach. Pharmacists must play a leading role in proactive infection management to address this critical issue and help patients fully benefit from these groundbreaking therapies.