Supportive Care and CRS Mitigation With Bispecific Antibodies in Multiple Myeloma

Dr. Hans Lee, Dr. Muhamed Baljevic, and Dr. Prashant Kapoor discuss supportive care considerations for patients receiving T-cell redirecting therapies, with a focus on infection prevention and mitigation of cytokine release syndrome (CRS) during bispecific antibody step-up dosing. The experts highlight the importance of IVIG and antimicrobial prophylaxis to reduce infectious complications associated with BCMA-directed bispecific therapy. They also discuss evolving approaches to outpatient step-up dosing, including prophylactic tocilizumab and corticosteroids, and share their institutional experiences with ambulatory administration. Dr. Baljevic describes how prophylactic tocilizumab may substantially reduce the incidence and severity of CRS without an apparent impact on treatment efficacy, while dexamethasone-based prophylaxis is being explored as a potentially more accessible strategy. The panel also considers how CRS mitigation strategies and streamlined monitoring could expand access to bispecific therapies, particularly in community settings. Dr. Kapoor emphasizes the importance of evaluating these approaches from the patient perspective, including their potential impact on quality of life and treatment burden.