Adverse Effects Related to Bispecifics in Multiple Myeloma

This is a video synopsis/summary of a Peer Exchange featuring Krina K. Patel, MD, MSc; Amrita Krishnan, MD; Caitlin Costello, MD; Saad Z. Usmani, MD, MBA, FACP; and Rafat Abonour, MD.

The discussion focuses on adverse effects with B-cell maturation antigen (BCMA)–targeted bispecific antibodies. Cytokine release syndrome (CRS) from immune activation is common, manifesting as flu-like fever, tachycardia, hypotension, or hypoxemia, but high-grade CRS is rare. Neurotoxicity can also occur, usually low grade manifesting as headaches or sensory changes, but more severe immune effector cell–associated neurotoxicity syndrome is possible. Careful monitoring, especially early during step-up dosing, is imperative.

A major late effect is immunosuppression and infections. Intravenous immunoglobulin replacement is routinely used given profound B-cell aplasia. Prophylactic antibiotics or antivirals can be considered, but aggressively evaluating and treating suspected infections is critical. Myeloma patients are already immunocompromised at baseline from prior therapies, so infections require prompt evaluation and treatment in this population. Establishing relationships with infectious disease specialists is advised to help comanage infections with these novel immunotherapies.

Video synopsis is AI-generated and reviewed by OncLive® editorial staff.