Administration Route and Infection Prevention With Bispecific Antibodies in DLBCL

Drs Chavez and Phillips discuss practical considerations beyond CRS and ICANS for patients with relapsed/refractory DLBCL receiving bispecific antibodies. Dr. Phillips notes that although subcutaneous formulations reduce chair time, injection site reactions can be bothersome, and many previously treated patients are comfortable with intravenous infusions. Dr. Chavez agrees, adding that these reactions may persist for months, can resemble infection, and warrant proactive counseling. The conversation then turns to infections, which Dr. Chavez identifies as a greater practical concern than CRS, since they can emerge late in treatment. The physicians review their approaches to antiviral and Pneumocystis jirovecii pneumonia prophylaxis during and after the steroid-intensive step-up period with epcoritamab. Dr. Chavez describes when he considers stopping prophylaxis based on immune recovery, including IgG levels, blood counts, and CD4 counts, and Dr. Phillips highlights the potential value of a standardized adverse event management algorithm for community oncologists.