Supportive Care and Toxicity Management in Relapsed/Refractory Multiple Myeloma

The panel discusses supportive care strategies for safely administering BCMA-directed therapies in relapsed/refractory multiple myeloma, with particular attention to bispecific antibodies and belantamab mafodotin. Dr. Douglas Sborov describes his approach to outpatient bispecific administration, including prophylactic tocilizumab, home temperature monitoring, and a “pill-in-the-pocket” dexamethasone strategy for managing low-grade cytokine release syndrome. He notes that clinically significant CRS and ICANS are uncommon with this approach and emphasizes the potential for community-based outpatient delivery. Dr. Hans Lee discusses the timing of CRS risk during initial step-up dosing and the potential for community practices to manage step-up dosing with appropriate protocols. The conversation then shifts to ocular toxicity associated with belantamab mafodotin. Dr. Paul Richardson emphasizes the importance of dose-schedule modification, regular ophthalmologic monitoring, artificial tears, eye hygiene, and management of preexisting ocular conditions such as cataracts. He also discusses the importance of understanding the specific grading system used for ocular findings and monitoring other potential adverse events, including thrombocytopenia and liver abnormalities.