Correspondence on 'Characteristics of second primary malignancies following bispecific antibodies therapy' by Liang et al.

We commend Liang et al for shining a spotlight on second primary malignancies after bispecific antibody (BsAb) therapy, yet several clinical nuances deserve consideration. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS)-derived case-fatality rates likely overstate risk, prior genotoxic treatments confound causality, and pooling heterogeneous BsAb constructs may blur construct-specific signals. The 124-day median latency hints at misclassification, while sparse African data limit global relevance. Risk-adapted surveillance-grounded in clonal haematopoiesis, prior cytotoxic exposure and BsAb construct-may be more pragmatic than blanket monitoring.