Optimal Use of T-Cell-Engaging Bispecific Antibodies in Multiple Myeloma

Publication Date: May 16, 2024
Last Updated: May 31, 2024

Key Points

  1. Cytokine release syndrome is a systemic inflammatory reaction caused by T-cell activation and the release of pro-inflammatory cytokines. ​
  2. Bispecific antibodies currently in clinical development for multiple myeloma induce cytokine release syndrome, which is mostly grade 1 or 2. ​
  3. The frequency of cytokine release syndrome varies between different bispecific antibodies due to various factors. ​
  4. Diagnostic investigation of cytokine release syndrome involves a detailed medical history, physical examination, and laboratory investigations. ​
  5. Prophylactic use of tocilizumab has been evaluated to reduce the incidence of cytokine release syndrome. ​
  6. The grading and management of cytokine release syndrome involve different strategies based on the severity of the syndrome. ​
  7. Neurological complications associated with bispecific antibodies include headache, immune effector cell-associated neurological toxicity, and peripheral neuropathy. ​
  8. The frequency of neurological complications in clinical trials varies between different bispecific antibodies. ​
  9. The evaluation and management of neurotoxicity involve neurological examinations, scoring systems, and diagnostic investigations. ​
  10. Corticosteroids, particularly dexamethasone, are the preferred treatment for immune effector cell-associated neurological toxicity. ​
  11. Prophylaxis with non-sedating anti-epileptic drugs can be considered. ​
  12. Persistent neurotoxicity might require a neurology consultation and the use of alternative agents. ​
  13. Peripheral neuropathy can worsen on therapy and might require temporary interruption or steroid treatment.



Optimal Use of T-Cell-Engaging Bispecific Antibodies in Multiple Myeloma

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