Oncology pharmacists are exploring ways to reduce hospitalization for step-up dosing in myeloma patients without compromising safety. Recent educational programs have reported significant variability across institutions in how long patients are hospitalized for this procedure.
The decision to hospitalize patients for step-up dosing is driven by various factors, including the patient’s condition and the institution’s experience with bispecific antibody administration.
Step-Up Dosing Criteria
More experienced centers are using real-world evidence to safely compress hospitalization timelines, while newer centers tend to follow package insert guidance, which can result in longer hospital stays. Published data supports abbreviated step-up schedules for teclistamab, demonstrating equivalent safety with shorter hospitalization.
Institutions are using specific patient and disease characteristics to determine outpatient versus inpatient eligibility. Outpatient candidates typically have a dedicated caregiver, can remain within a 30-minute radius of the treating center, and do not have high-risk disease features.
High-risk patients require inpatient observation due to the heightened risk of severe CRS manifestations. Experts emphasize that geographic proximity to a CRS-capable emergency facility is a non-negotiable safety requirement, limiting outpatient eligibility for patients in rural or underserved areas.
Real-World Experience and Clinical Comfort
As real-world experience accumulates and clinical comfort with CRS and neurotoxicity management grows, the field is moving toward broader outpatient step-up dosing. This shift is expected to continue as clinicians become more comfortable managing potential side effects.
In practice, this development means that patients who would have previously required lengthy hospital stays may now be able to receive step-up dosing on an outpatient basis, provided they meet specific criteria and have access to a nearby emergency facility. This change could significantly impact the lives of patients with myeloma, allowing them to receive treatment with minimal disruption to their daily lives.
The next episode in this series will feature the panelists discussing clinical presentation, appropriate response, and building a well-educated care team for multiple myeloma patients. They will focus on what Grade 1 CRS looks like in clinical practice and how institutions are building the necessary education infrastructure to ensure appropriate response to potential CRS symptoms.
Panelists will explore how nursing staff, emergency department teams, and inpatient providers can respond appropriately when patients present with potential CRS symptoms. This conversation is essential in ensuring that patients receive the best possible care, regardless of whether they are being treated as inpatients or outpatients.
Experts will provide a reflection on the field and the factors that may shape how clinicians approach care moving forward. The discussion will outline the specific patient and disease characteristics that institutions are using to determine outpatient eligibility.
They will discuss the importance of access to a nearby emergency facility.
