Scientific publications
Prevention and management of adverse events during treatment with bispecific antibodies and CAR T cells in multiple myeloma: a consensus report of the European Myeloma Network. Scientific Publication
Heinz Ludwig 1 , Evangelos Terpos 2 , Niels van de Donk 3 , Maria-Victoria Mateos 4 , Philippe Moreau 5 , Melitios-Athanasios Dimopoulos 2 , Michel Delforge 6 , Paula Rodriguez-Otero 7 , Jesús San-Miguel 7 , Kwee Yong 8 , Francesca Gay 9 , Hermann Einsele 10 , Roberto Mina 9 , Jo Caers 11 , Christoph Driessen 12 , Pellegrino Musto 13 , Sonja Zweegman 3 , Monika Engelhardt 14 , Gordon Cook 15 , Katja Weisel 16 , Annemiek Broijl 17 , Meral Beksac 18 , Jelena Bila 19 , Fredrik Schjesvold 20 , Michele Cavo 21 , Roman Hajek 22 , Cyrille Touzeau 5 , Mario Boccadoro 9 , Pieter Sonneveld 17
Abstract
T-cell redirecting bispecific antibodies (BsAbs) and chimeric antigen receptor T cells (CAR T cells) have revolutionised multiple myeloma therapy, but adverse events such as cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome (ICANS), cytopenias, hypogammaglobulinaemia, and infections are common.
This Policy Review presents a consensus from the European Myeloma Network on the prevention and management of these adverse events. Recommended measures include premedication, frequent assessing for symptoms and severity of cytokine release syndrome, step-up dosing for several BsAbs and some CAR T-cell therapies; corticosteroids; and tocilizumab in the case of cytokine release syndrome.
Other anti-IL-6 drugs, high-dose corticosteroids, and anakinra might be considered in refractory cases. ICANS often arises concomitantly with cytokine release syndrome. Glucocorticosteroids in increasing doses are recommended if needed, as well as anakinra if the response is inadequate, and anticonvulsants if convulsions occur.
Preventive measures against infections include antiviral and antibacterial drugs and administration of immunoglobulins. Treatment of infections and other complications is also addressed.
CITATION Lancet Oncol. 2023 Jun;24(6):e255-e269. doi: 10.1016/S1470-2045(23)00159-6