Outpatient CRS Management and Infection Prevention

This segment focuses on practical strategies for early recognition and management of CRS in the outpatient setting, along with approaches to prevent infections during bispecific antibody therapy. The panel emphasizes that patient education and clear care pathways are critical for safely managing treatment outside the hospital.

Clinicians highlight the importance of providing patients and caregivers with clear written instructions and symptom checklists, including when to call the care team and which medications to keep on hand, such as acetaminophen or dexamethasone. Grade 1 CRS can often be managed at home with supportive care and corticosteroids, whereas grade ≥2 symptoms require hospital evaluation. Caregiver involvement is essential, particularly for recognizing neurologic symptoms suggestive of ICANS, though severe neurotoxicity is reported less frequently with bispecific antibodies than with CAR T-cell therapy.

The discussion then shifts to infection risk during therapy, noting that immunosuppression from treatment and corticosteroid use increases susceptibility to opportunistic infections. Preventive strategies commonly include antiviral prophylaxis, Pneumocystis prophylaxis, and monitoring immunoglobulin levels, with IVIG replacement used when IgG levels decline or infections occur. Panelists also stress maintaining close collaboration with infectious disease specialists and remaining vigilant for atypical infections in heavily pretreated patients receiving modern immunotherapies.