Managing the Long-Term Tolerability of Teclistamab in Multiple Myeloma

Luciano Costa, MD, PhD, Director of the Multiple Myeloma Research and Treatment Program at the University of Alabama at Birmingham, emphasizes that the primary take-home message regarding the combination of teclistamab (Tecvayli) and daratumumab (Darzalex) is that it is a highly effective therapy compared with other second-line options. Although the efficacy is profound, he notes that there are essential nuances in clinical implementation that providers must navigate to ensure patients receive the long-term benefits of the treatment.

Focusing on Long-Term Toxicities

Costa points out that cytokine release syndrome (CRS) typically occurs only during the first week of treatment, and in a cohort of 300 treated patients, there were no deaths and no instances of patients becoming critically ill from the syndrome. Consequently, he argues that CRS should not be viewed as a major deterrent to the use of teclistamab.

He identifies the increased risk of infection as the most significant safety challenge when using bispecific antibodies that engage the body’s T cells. However, he notes that this risk is manageable through the use of well-developed, published, and validated guidelines. Specifically, he references the guidelines provided by the International Myeloma Working Group, among others, which are designed to greatly reduce infection rates.

Implementation of Prophylaxis Guidelines

For clinicians utilizing these therapies, Costa discusses on the full implementation of safety protocols. According to the guidelines, the minimum standard of care should include intravenous immunoglobulin replacement therapy, preventative treatment for Pneumocystis jirovecii pneumonia and Varicella-zoster virus, and a proactive workup and management plan for any patient presenting with signs or symptoms of a potential infection.

He concludes that by strictly adhering to these established safety measures, clinicians can deliver immense value and durable disease control to their patients.