Douglas Sborov, MD, MS

Panelists discuss how, for a patient who has an aggressive disease, physicians will plan for monthly serum markers including serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE); if they start seeing an increase in the disease, they plan an imaging for bone marrow biopsy and consider a diagnostics lumbar puncture.

Panelists note that while both teclistamab and elranatamab are weekly doses, elranatamab is a flat dose, and physicians have seen quick and positive responses to elranatamab treatment and physicians have seen…treatment and have been able to pull back patients from doses earlier to prevent an increase in adverse effects from infection.

Panelists discuss how patient 3 is a 61-year-old man with R-ISS stage III IgG-L double-hit myeloma/plasma cell leukemia and extramedullary plasmacytoma diagnosed in 2023 s/p radiation, now with a CNS relapse on elranatamab.

Panelists discuss how a patient who is neutropenic is given supportive care with GCSF, as do patients who have prolonged neutropenia, then that patient will be on antibiotic and antifungal prophylaxis.

Panelists discuss how recent PET is reviewed with the patient, and there is evidence of near resolution of PET avid EMD lesions, though they will continue to monitor adenopathy – most suspicious for a reactive process. For patients treated with IVIG, the goal is to maintain a biological level of IgG at 400 mg/dL.

Panelists discuss how patient 2 is a 55-year-old female with R/R MM including multiple EMD progressions now s/p Abecma. The patient is now s/p radiation for cutaneous lesions and continues talquetamab.

Panelists note how they always discuss the pro and cons of each treatment with their patients and the treatment efficiency’s, highlighting the most common and dangerous adverse effects. Panelists discuss the importance of closely monitoring patients and providing ongoing supportive care.

Panelists discuss how any patient receiving a bispecific antibody should be given IVIG for their hypogammaglobulinemia and patients should be treated with this monthly for the first 6 months of treatment.

Panelists discuss how an early adverse event for this drug class no matter what the mechanism or target is, is cytokine release syndrome (CRS), and it tends to occur on a timescale that is predictable. When treating patients in the outpatient setting, they receive dexamethasone, given at the first fever, which is the first sign of cytokine release syndrome (CRS) and helps mitigate it.

Panelists discuss how this patient was admitted after the day 1 dose of talquetamab for observation for CRS and ICANS. Patients such as this are given a 0.01-mg/kg dose on the first day, a 0.06-mg/kg dose on day 3, and a 0.04-mg/kg dose on day 5 if there are no issues. The patient is then monitored for 48 hours and is discharged before getting the 0.08-mg/kg dose.

Panelists discuss how patient 1 is a 76-year-old female with unknown- stage R-ISS, oligosecretory IgG-K/KLC MM currently treated with talquetamab. One year following the talquetamab initiation, she is in VGPR/MRD- (likely CR or sCR as IFE positive is LLC and she has KLC). To spare toxicity physicians have decreased her dosing to monthly, starting with cycle 14 day 1.