Recent advancements in multiple myeloma (MM) therapies have extended survival but introduced immunosuppressive challenges, including hypogammaglobulinemia, which increases infection risk. T-cell engaging therapies have improved outcomes for heavily pretreated patients, extending survival beyond 2 to 3 years, but contribute to immune dysfunction. Immunoglobulin replacement therapy (IgG-RT), including intravenous and subcutaneous options, shows promise in reducing infection-related morbidity, particularly for those with severe or recurrent infections.

While IgG-RT effectively reduces serious bacterial infections, its impact on overall survival remains unclear. Inconsistent management strategies and a lack of standardization highlight the need for prospective trials to establish optimal use. A multidisciplinary approach combining hematology/oncology and immunology expertise is crucial to address MM’s immunologic complexities. Future research should focus on improved biomarkers, standardized protocols, and a deeper understanding of immune mechanisms to optimize IgG-RT and enhance patient outcomes.

Reference: Wonnaparhown A, Hilal T, Squire J, Freeman C, Fonseca R. IgG replacement in multiple myeloma. Blood Cancer J. 2024;14(1):124. doi: 10.1038/s41408-024-01107-6.