Optimal Use of T-Cell-Engaging Bispecific Antibodies in Multiple Myeloma
Publication Date: May 16, 2024
Last Updated: May 31, 2024
Key Points
- Cytokine release syndrome is a systemic inflammatory reaction caused by T-cell activation and the release of pro-inflammatory cytokines.
- Bispecific antibodies currently in clinical development for multiple myeloma induce cytokine release syndrome, which is mostly grade 1 or 2.
- The frequency of cytokine release syndrome varies between different bispecific antibodies due to various factors.
- Diagnostic investigation of cytokine release syndrome involves a detailed medical history, physical examination, and laboratory investigations.
- Prophylactic use of tocilizumab has been evaluated to reduce the incidence of cytokine release syndrome.
- The grading and management of cytokine release syndrome involve different strategies based on the severity of the syndrome.
- Neurological complications associated with bispecific antibodies include headache, immune effector cell-associated neurological toxicity, and peripheral neuropathy.
- The frequency of neurological complications in clinical trials varies between different bispecific antibodies.
- The evaluation and management of neurotoxicity involve neurological examinations, scoring systems, and diagnostic investigations.
- Corticosteroids, particularly dexamethasone, are the preferred treatment for immune effector cell-associated neurological toxicity.
- Prophylaxis with non-sedating anti-epileptic drugs can be considered.
- Persistent neurotoxicity might require a neurology consultation and the use of alternative agents.
- Peripheral neuropathy can worsen on therapy and might require temporary interruption or steroid treatment.
Overview
Title
Optimal Use of T-Cell-Engaging Bispecific Antibodies in Multiple Myeloma
Authoring Organization
International Myeloma Working Group