Reduced CRS Rates Support Wider Adoption of Bispecifics in Myeloma

Although the clinical data supporting the combination of teclistamab and daratumumab are exceptional, Luciano Costa, MD, PhD, Director of the Multiple Myeloma Research and Treatment Program at the University of Alabama at Birminghamacknowledges that adoption of bispecific antibodies remains a challenge. He attributes much of this hesitation to the perceived toxicity of cytokine release syndrome (CRS) and the logistical requirements of the Risk Evaluation and Mitigation Strategy (REMS) program.

Reassessing CRS and Hospitalization Barriers

Costa points out that during the MajesTEC-3 trial, patients were hospitalized during the initial step-up dosing phase. For many community centers, this requirement creates both a logistical hurdle and a financial barrier to treatment. However, he argues that the safety data from the trial offer a reassuring counter-narrative, as no patient in the study had grade 3 or higher CRS, and in the majority of patients, the syndrome manifested as nothing more than a fever. Only about 1 in 6 patients required additional supportive care, such as short-term fluids or oxygen, and it presents early in treatment.

Transitioning to Outpatient Care

Because the toxicity profile does not strictly necessitate a hospital setting, many practices across the country are already transitioning to entirely outpatient administration. This shift is supported by proactive mitigation strategies, including the use of prophylactic tocilizumab and more liberal application of corticosteroids.

The New Standard of Care

Costa emphasizes that bispecific antibodies are no longer “exception” therapies reserved for late-stage disease in academic settings. As these regimens move into the second-line setting, they have become mainstream. He argues that it is now essential for everyone treating multiple myeloma to gain familiarity with these agents. Through continued peer education and the sharing of mitigation strategies, Costa believes the community will build the comfort necessary to deliver this highly effective therapy to a broader patient base.