Optimal Use of T-Cell-Engaging Bispecific Antibodies in Multiple Myeloma
Key Points
- Cytokine release syndrome is a systemic inflammatory reaction caused by T-cell activation and the release of pro-inflammatory cytokines.
- Bispecific antibodies currently in clinical development for multiple myeloma induce cytokine release syndrome, which is mostly grade 1 or 2.
- The frequency of cytokine release syndrome varies between different bispecific antibodies due to various factors.
- Diagnostic investigation of cytokine release syndrome involves a detailed medical history, physical examination, and laboratory investigations.
- Prophylactic use of tocilizumab has been evaluated to reduce the incidence of cytokine release syndrome.
- The grading and management of cytokine release syndrome involve different strategies based on the severity of the syndrome.
- Neurological complications associated with bispecific antibodies include headache, immune effector cell-associated neurological toxicity, and peripheral neuropathy.
- The frequency of neurological complications in clinical trials varies between different bispecific antibodies.
- The evaluation and management of neurotoxicity involve neurological examinations, scoring systems, and diagnostic investigations.
- Corticosteroids, particularly dexamethasone, are the preferred treatment for immune effector cell-associated neurological toxicity.
- Prophylaxis with non-sedating anti-epileptic drugs can be considered.
- Persistent neurotoxicity might require a neurology consultation and the use of alternative agents.
- Peripheral neuropathy can worsen on therapy and might require temporary interruption or steroid treatment.
Recommendation Grading
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Overview
Title
Optimal Use of T-Cell-Engaging Bispecific Antibodies in Multiple Myeloma
Authoring Organization
International Myeloma Working Group
Publication Month/Year
May 16, 2024
Last Updated Month/Year
May 31, 2024
Document Type
Guideline
Country of Publication
Global
Document Objectives
Multiple myeloma remains an incurable disease, despite the development of numerous drug classes and combinations that have contributed to improved overall survival. Immunotherapies directed against cancer cell-surface antigens, such as chimeric antigen receptor (CAR) T-cell therapy and T-cell-redirecting bispecific antibodies, have recently received regulatory approvals and shown unprecedented efficacy. However, these immunotherapies have unique mechanisms of action and toxicities that are different to previous treatments for myeloma, so experiences from clinical trials and early access programmes are essential for providing specific recommendations for management of patients, especially as these agents become available across many parts of the world. Here, we provide expert consensus clinical practice guidelines for the use of bispecific antibodies for the treatment of myeloma. The International Myeloma Working Group is also involved in the collection of prospective real-time data of patients treated with such immunotherapies, with the aim of learning continuously and adapting clinical practices to optimise the management of patients receiving immunotherapies.
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D009101 - Multiple Myeloma
Keywords
multiple myeloma, T-Cell-Engaging Bispecific Antibodies
Source Citation
Rodriguez-Otero P, Usmani S, Cohen AD, van de Donk NWCJ, Leleu X, Gállego Pérez-Larraya J, Manier S, Nooka AK, Mateos MV, Einsele H, Minnema M, Cavo M, Derman BA, Puig N, Gay F, Ho PJ, Chng WJ, Kastritis E, Gahrton G, Weisel K, Nagarajan C, Schjesvold F, Mikhael J, Costa L, Raje NS, Zamagni E, Hájek R, Weinhold N, Yong K, Ye JC, Sidhana S, Merlini G, Martin T, Lin Y, Chari A, Popat R, Kaufman JL; International Myeloma Working Group. International Myeloma Working Group immunotherapy committee consensus guidelines and recommendations for optimal use of T-cell-engaging bispecific antibodies in multiple myeloma. Lancet Oncol. 2024 May;25(5):e205-e216. doi: 10.1016/S1470-2045(24)00043-3. PMID: 38697166.