# T-cell exhaustion due to BiTE therapy in multiple myeloma: mitigating infectious risks through treatment-free intervals

## TL;DR

This paper reviews how BiTE therapy for multiple myeloma can lead to T-cell exhaustion and increased infection risks, suggesting treatment-free intervals to mitigate these issues.

## Contribution

The paper introduces the concept of treatment-free intervals to address T-cell exhaustion caused by BiTE therapy in multiple myeloma.

## Key findings

- BiTE therapy can cause T-cell exhaustion, leading to immunosuppression and increased infection risks.
- Treatment-free intervals may help mitigate these risks by allowing T-cells to recover.
- CAR T-cell therapy offers durable responses but differs from BiTE in its treatment paradigm.

## Abstract

Multiple Myeloma (MM), a highly treatable but thus far incurable hematologic malignancy, has required continuous monitoring and treatment throughout a patient’s lifetime. Newer classes of therapies, such as chimeric antigen receptor (CAR) T-cell therapy which constitutes of a one-time infusion, have challenged the continuous treatment paradigm. Compared to previously known standard therapies, CAR T-cell therapy along with bispecific T-cell engager (BiTE) therapy have been observed to induce deeper responses that tend to be durable in responders. However, the degree of immunosuppression and infection noted especially with BiTE therapies, currently approved for ongoing administration until progression of disease, has given rise to the idea of incorporating treatment-free intervals. This review describes T-cell exhaustion as a driver for immunosuppression and infection in patients with MM receiving BiTE therapy and discusses potential ways to overcome it to improve management of patients.