Practical CRS Management and Sequencing Decisions in the Era of Earlier-Line Immunotherapy

Drs Paul Richardson and Hans Lee address real-world strategies for managing cytokine release syndrome and how these considerations intersect with evolving treatment sequencing in multiple myeloma. The discussion focuses on practical approaches to CRS mitigation, including when to use tocilizumab prophylactically versus reserving it for emerging grade 2 events, and how dexamethasone may be incorporated in outpatient settings. Dr Lee emphasizes that CRS with bispecific antibodies is often low grade and manageable, while reinforcing the importance of vigilant supportive care and early evaluation of febrile patients to prevent serious complications. The conversation then broadens to sequencing decisions as BCMA-directed CAR T-cell therapy moves into earlier lines of relapse. The faculty compare CAR T-cell therapy and bispecific antibodies in terms of durability, access, and real-world feasibility, highlighting the growing role of off-the-shelf bispecifics for patients who may not have timely access to cellular therapy. This segment underscores how thoughtful CRS management and expanding therapeutic options are reshaping earlier-line myeloma care.