Catamero on Challenges of Community-Based Administration of Bispecifics and CAR T-Cell Therapy in Myeloma

“As a myeloma community, we really need to focus on training out nurses [and] physicians [in the community] on how to manage patients undergoing bispecific therapy. With CAR [T-cell therapy], patients do need to be at a CAR T center.”

Donna Catamero, ANP-BC, OCN, CCRC, director of myeloma research at Icahn School of Medicine the Mount Sinai Hospital, discussed the challenges community-based clinicians face in delivering bispecific antibodies and CAR T-cell therapy for patients with multiple myeloma.

During an interview at the 22nd Annual International Myeloma Society Annual Meeting, Catamero explained that despite promising efficacy data displayed by these agents in prospective clinical trials and their subsequent approvals by the FDA, many community centers encounter barriers that limit their ability to implement these therapies. With bispecific antibodies, step-up dosing schedules require close monitoring and repeated visits, which many centers are not resourced to manage, Catamero explained. Additionally, she noted that nursing and physician teams often lack the specialized training needed to recognize and address unique toxicities associated with these therapies.

Catamero emphasized that access to CAR T-cell therapy is similarly complex, as patients must receive treatment at specialized CAR T centers. However, once infused, patients typically transition back to their local clinic for follow-up care. She explained that this creates a gap between academic and community practices, particularly around the recognition and management of expected post-infusion adverse effects. Without adequate knowledge sharing and support, community clinicians may be uncertain how to manage complications or when to escalate back to the treating center.

To address these challenges, Catamero underscored the importance of education and collaboration. Training community-based providers—both physicians and nurses—on dosing logistics, toxicity management, and surveillance protocols is essential, she said. She added that standardized handoff tools, clear monitoring guidelines, and accessible consultation pathways could help bridge the gap between academic centers and local practices.

Catamero concluded that improving the flow of information and building competency in managing treatment-related toxicities are critical steps toward expanding safe access to bispecific antibodies and CAR T-cell therapy. Strengthening partnerships between academic and community centers, she noted, will be necessary to reduce disparities in access and ensure continuity of care for patients with multiple myeloma.