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Real World Insights: Bispecific Antibodies in R/R MM

Video Series

Relapsed/Refractory Multiple Myeloma

Panelists discuss how any patient receiving a bispecific antibody should be given IVIG for their hypogammaglobulinemia and patients should be treated with this monthly for the first 6 months of treatment. 

Strategies For Management of Infections

Video content above is prompted by the following:

What are we doing to help mitigate these infections and the possibility that the patient may be getting sick?

Videos

Douglas Sborov, MD; Mary Steinbach, NP; and Kelley Julian, PharmD, BCOP, discuss 3 complex cases of patients with myeloma with late-line, heavily pretreated disease and why they opted to treat these patients with BCMA- and GPRC5D-directed bispecifics. They also focus on expected toxicities and supportive care strategies to maximize patient tolerability of R/R MM treatment drugs and drug sequencing in patients who are difficult to treat.

Panelists discuss how patient 1 is a 76-year-old female with unknown- stage R-ISS, oligosecretory IgG-K/KLC MM currently treated with talquetamab. One year following the talquetamab initiation, she is in VGPR/MRD- (likely CR or sCR as IFE positive is LLC and she has KLC). To spare toxicity physicians have decreased her dosing to monthly, starting with cycle 14 day 1.

Meet a 76-Year-Old Patient With Late-Line R/R MM, Unsuitable For CAR T Therapy

Panelists discuss how this patient was admitted after the day 1 dose of talquetamab for observation for CRS and ICANS. Patients such as this are given a 0.01-mg/kg dose on the first day, a 0.06-mg/kg dose on day 3, and a 0.04-mg/kg dose on day 5 if there are no issues. The patient is then monitored for 48 hours and is discharged before getting the 
0.08-mg/kg dose. 


Role of Step-Up Dosing

Panelists discuss how an early adverse event for this drug class no matter what the mechanism or target is, is cytokine release syndrome (CRS), and it tends to occur on a timescale that is predictable. When treating patients in the outpatient setting, they receive dexamethasone, given at the first fever, which is the first sign of cytokine release syndrome (CRS) and helps mitigate it.

Dosing Frequency, and Adverse Event Management With Bispecific Therapy

Panelists note how they always discuss the pro and cons of each treatment with their patients and the treatment efficiency’s, highlighting the most common and dangerous adverse effects. Panelists discuss the importance of closely monitoring patients and providing ongoing supportive care. 

Optimizing Treatment Goals and Supportive Care For Relapsed/Refractory Multiple Myeloma in Older Patients

Panelists discuss how patient 2 is a 55-year-old female with R/R MM including multiple EMD progressions now s/p Abecma. The patient is now s/p radiation for cutaneous lesions and continues talquetamab. 

Meet a 55-Year-Old Who Was Refractory to or Relapsed on BCMA CAR T Therapy

Panelists discuss how recent PET is reviewed with the patient, and there is evidence of near resolution of PET avid EMD lesions, though they will continue to monitor adenopathy – most suspicious for a reactive process. For patients treated with IVIG, the goal is to maintain a biological level of IgG at 400 mg/dL.

Patient Tolerability of Talquetamab and Use of IVIG

Panelists discuss how a patient who is neutropenic is given supportive care with GCSF, as do patients who have prolonged neutropenia, then that patient will be on antibiotic and antifungal prophylaxis. 

Strategizing Talquetamab Use In Relapsed/Refractory Multiple Myeloma: Balancing Efficacy, Infection Control, and Next-Line Therapy

Strategies For Management of Infections

EP: 1.Meet a 76-Year-Old Patient With Late-Line R/R MM, Unsuitable For CAR T Therapy

EP: 2.Role of Step-Up Dosing

EP: 3.Dosing Frequency, and Adverse Event Management With Bispecific Therapy

EP: 4.Strategies For Management of Infections

EP: 5.Optimizing Treatment Goals and Supportive Care For Relapsed/Refractory Multiple Myeloma in Older Patients

EP: 6.Meet a 55-Year-Old Who Was Refractory to or Relapsed on BCMA CAR T Therapy

EP: 7.Patient Tolerability of Talquetamab and Use of IVIG

EP: 8.Strategizing Talquetamab Use In Relapsed/Refractory Multiple Myeloma: Balancing Efficacy, Infection Control, and Next-Line Therapy