Infections in lymphoma patients treated with bispecific antibodies: A systematic review and meta-analysis.

Bispecific antibodies (BsAb) have rapidly entered the treatment paradigms of both indolent and aggressive lymphomas. Infection is a commonly reported toxicity of BsAb therapy, however characterization of infection patients among patients treated with BsAbs is poorly understood. A systematic review and meta-analysis of published studies of CD20-directed BsAb-treated lymphoma patients was performed. Twenty-seven studies, including 2100 patients, were included. Median follow-up was 12 months; 17% of patients had received prior cellular therapies. The pooled prevalence of infections of any-grade was 44% (95%CI:37-50%), with a prevalence of grade ≥3 infections of 20% (95CI:15-21%) and 3% of patients experiencing fatal infections (95%CI:2-5%). Infection rates did not differ between patients with aggressive or indolent lymphomas, or between BsAb monotherapy and combination therapy. Viral infections constituted a significant proportion (41%) of fatal infections. Future studies should closely examine the incidence of, and risk factors for, severe infections classically associated with T-cell depletion. As BsAbs are progressively incorporated into lymphoma treatment paradigms, the risk of infection needs to be comprehensively profiled, monitored and proactively managed with multidisciplinary approaches.