The advent of bispecific antibodies like teclistamab and elranatamab has revolutionized the management of relapsed and refractory multiple myeloma (RRMM). This study from the University of Miami explores the efficacy of prophylactic tocilizumab in mitigating cytokine release syndrome (CRS) associated with these therapies. Findings suggest a promising role for tocilizumab in reducing CRS rates, although challenges such as immune-related adverse events and infections persist. Further randomized trials are needed to validate these results and optimize treatment strategies.

Key Points:

• Bispecific antibodies (teclistamab, elranatamab, talquetamab) show high response rates in RRMM.
• Prophylactic tocilizumab reduced CRS incidence to 14% in treated patients.
• Study included 72 RRMM patients treated with bispecific antibodies.
• CRS and ICANS rates varied among teclistamab, elranatamab, and talquetamab.
• Majority of CRS events were grade 1; few grade 2 incidents observed.
• ICANS events included grades 1-3, with notable severe cases reported.
• Significant incidence of infections (47%) and neutropenia (53%) noted.
• Overall response rate (ORR) was 66%, varying by specific antibody.
• Median duration of response not reached; 53% patients continue therapy.
• Need for larger randomized trials to confirm findings and optimize management.

Authors:
Andrew Kowalski, PharmD; Jill Lykon, PharmD; Benjamin Diamond, MD; David G. Coffey, MD; Marcella Kaddoura, MD; Francesco Maura, MD; James E. Hoffman, MD; Dickran Kazandjian, MD; Ola Landgren