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.

Publication

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.

Journal Paper/Review - Jun 1, 2023

Ludwig Heinz, Terpos Evangelos, van de Donk Niels, Mateos Maria-Victoria, Moreau Philippe, Dimopoulos Melitios-Athanasios, Delforge Michel, Rodriguez-Otero Paula, San-Miguel Jesús F, Yong Kwee, Gay Francesca, Einsele Hermann, Mina Roberto, Caers Jo, Driessen Christoph, Musto Pellegrino, Zweegman Sonja, Engelhardt Monika, Cook Gordon, Weisel Katja, Broijl Annemiek, Beksac Meral, Bila Jelena, Schjesvold Fredrik, Cavo Michele, Hájek Roman, Touzeau Cyrille, Boccadoro Mario, Sonneveld Pieter

Citation

Ludwig H, Terpos E, van de Donk N, Mateos M, Moreau P, Dimopoulos M, Delforge M, Rodriguez-Otero P, San-Miguel J, Yong K, Gay F, Einsele H, Mina R, Caers J, Driessen C, Musto P, Zweegman S, Engelhardt M, Cook G, Weisel K, Broijl A, Beksac M, Bila J, Schjesvold F, Cavo M, Hájek R, Touzeau C, Boccadoro M, Sonneveld P. 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. Lancet Oncol 2023; 24:e255-e269.

Type

Journal Paper/Review (English)

Journal

Lancet Oncol 2023; 24

Publication Date

Jun 1, 2023

Issn Electronic

1474-5488

Pages

e255-e269

Brief description/objective

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.