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Clinicians increasingly use T-cell-engaging bispecific antibodies (BsAbs) to treat B-cell non-Hodgkin lymphoma (NHL) and multiple myeloma (MM). However, maintaining a clear understanding of the bispecific antibody safety profile is essential as these agents transition into earlier courses of therapy. One significant concern involves the development of second primary malignant neoplasms (SPMs), which can impact long-term survival and quality of life.
A recent systematic review and meta-analysis published in JAMA Oncology evaluated the frequency of these secondary cancers. The researchers analyzed 20 studies involving 2,551 patients to provide a reliable estimate of SPM occurrences. Their findings offer critical insights for hematologists and oncologists managing survivors of hematologic malignancies.
The study found that the random-effects meta-analysis yielded a pooled estimated SPM proportion of 3.5% at a median follow-up of 17.4 months. Specifically, disease-specific estimates reached 3.8% for NHL and 3.4% for MM. Furthermore, the analysis highlighted the clinical impact of these neoplasms. Approximately 2.2% of patients discontinued treatment due to SPMs, while 1.4% of reported cases led to death. Notably, the study found no significant associations between total SPM estimates and variables like age or prior therapy courses.
The bispecific antibody safety profile regarding SPMs is a measurable and clinically relevant complication. Although current follow-up periods remain relatively short, the results underscore the necessity for vigilant monitoring. Heterogeneous reporting currently complicates comprehensive assessments. Therefore, medical societies must advocate for standardized long-term safety surveillance in future clinical trials. Indian oncologists should consider regular screenings for secondary malignancies as BsAbs become more integrated into local standard care.
SPMs are new, independent cancers that develop in a patient who has a previous history of malignancy. They are distinct from the recurrence or metastasis of the original primary cancer.
According to the meta-analysis, the pooled frequency of SPMs is approximately 3.5% within a median follow-up period of about 17 months. This rate is similar across both non-Hodgkin lymphoma and multiple myeloma cohorts.
Yes. The study highlights that SPMs are a clinically significant risk. Consequently, clinicians should implement long-term surveillance and standardized safety reporting to manage these potential complications effectively.
Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.
References
1. Tomasik J et al. Second Primary Malignant Neoplasms After T-Cell-Engaging Bispecific Antibody Therapy: A Systematic Review and Meta-Analysis. JAMA Oncol. 2026 Jun 18. doi: 10.1001/jamaoncol.2026.1859. PMID: 42313425.
2. Liu D et al. Characteristics of second primary malignancies following bispecific antibodies therapy. J Immunother Cancer. 2025 Apr 1;13(4):e011200. doi: 10.1136/jitc-2024-011200.
3. Storgard R et al. T-Cell Malignant Neoplasms after Chimeric Antigen Receptor T-Cell Therapy. JAMA Oncol. 2024 Jun 20;10(6):826-828. doi: 10.1001/jamaoncol.2024.0662.
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A meta-analysis in JAMA Oncology reveals a 3.5% pooled frequency of second primary malignant neoplasms (SPMs) following T-cell-engaging bispecific antibody therapy for NHL and MM. The findings emphasize the need for standardized long-term safety surveillance as these therapies move to earlier lines of treatment.
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