# Infectious Complications in Patients with B-Cell Non-Hodgkin Lymphoma Treated with Bispecific Antibodies

## TL;DR

This paper reviews how bispecific antibodies used to treat B-cell lymphoma increase infection risks and discusses strategies to manage these complications.

## Contribution

The paper provides a focused review on infectious complications and prophylactic strategies in B-cell lymphoma patients treated with bispecific antibodies.

## Key findings

- BsABs treatment leads to profound B-cell depletion and T-cell exhaustion, increasing infection risks.
- Infections are a significant complication in BsABs-treated lymphoma patients, with no standardized prophylactic guidelines.
- Clinical trials during the COVID-19 pandemic highlight the importance of infection prevention strategies.

## Abstract

Even though infections constitute a significant complication of treatment with bispecific antibodies (BsABs), there are no structured guidelines for anti-infectious prophylaxis and treatment in the setting of therapy with lymphomas. In this review, we assess the occurrence of infectious complications in the course of BsABs treatment in patients with lymphomas. We also discuss the management strategies, like pharmacological prophylaxis of infections and prevention of hypogammaglobulinemia and neutropenia.

Bispecific antibodies (BsABs) have become a new standard of treatment of refractory/relapsed patients with diffuse large B-cell lymphoma and follicular lymphoma, being also intensively studied in other types of B-cell non-Hodgkin lymphoma (B-NHL). Since the therapy with BsABs results in profound B-cell depletion and T-cell exhaustion, it is associated with significantly increased risk of infections. Additional risk factors involve immune disorders caused by lymphoma itself and previous lines of therapy. In this review, we focus on the infectious complications in B-NHL patients treated BsABs, presenting their incidence in clinical trials, admittedly performed to a large extent during the COVID-19 pandemic, as well as the proposals of infection prophylaxis.