Expert oncologists and oncology pharmacists recently explored the management of adverse events associated with bispecific antibodies and CAR T-Cell therapies in patients with relapsed/refractory multiple myeloma.
The discussion focused on key adverse events, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).
Al-Ola Abdallah noted that while CRS occurs in over 70% of patients, most cases are grade 1 or 2 and can be managed in outpatient settings with proper infrastructure.
Adverse Events Associated with Bispecific Antibodies
ICANS is less commonly observed at severe grades compared to CAR T-Cell therapy, according to Abdallah.
He emphasized the importance of aggressive supportive care, including prompt hospitalization for fever, growth factor support for neutropenia, prophylactic antibiotics, and intravenous immunoglobulin (IVIG) for hypogammaglobulinemia.
This supportive care is critical, as grade 3 and 4 infection rates can reach 70%.
The frequency of hypogammaglobulinemia across all three B-cell maturation antigen (BCMA)-directed therapy classes highlights the need for careful monitoring and management of this condition.
Furthermore, the use of IVIG in this context may help mitigate the risks associated with hypogammaglobulinemia, and its implementation should be considered as part of a full supportive care strategy.
Managing Adverse Events in CAR T-Cell Therapies
Abdallah also reviewed the adverse event profile of CAR T-Cell therapies, describing a similar but more severe toxicity profile compared to bispecifics.
Prolonged cytopenia is a particular challenge, where stem cell boost may offer benefit.
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Rare but emerging concerns, including delayed neurological toxicity with Parkinsonian features and enterocolitis, require close monitoring at high-volume centers.
The single-infusion administration of CAR T-Cell therapies contributes to their distinct toxicity profile, showing the need for specialized care and monitoring protocols.
As these therapies continue to evolve, it’s essential to consider the practical implications for patients and healthcare settings, particularly in terms of resource allocation and staffing.
For instance, the need for prompt hospitalization and aggressive supportive care may necessitate additional resources and infrastructure.
Moreover, the rare but emerging concerns associated with CAR T-Cell therapies may require specialized training and equipment.
The experts’ discussion provided valuable insights into the management of adverse events associated with these therapies.
According to the report, the experts will continue their discussion on relapsed/refractory multiple myeloma in a future episode, focusing on pharmacist-led patient education and overcoming barriers in BCMA-targeted therapy.
This future discussion will look into the key role pharmacists play in educating patients receiving BCMA-targeted therapies and addressing the remaining unmet needs for successful utilization of these agents.
By exploring the factors that shape how clinicians approach care, the experts aim to provide a full understanding of the field and its future directions.
