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

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

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

26 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)e255-e269
JournalThe Lancet Oncology
Volume24
Issue number6
DOIs
Publication statusPublished - Jun 2023

Bibliographical note

Funding Information:
Writing of this manuscript was supported in part by the Austrian Forum Against Cancer.

Publisher Copyright:
© 2023 Elsevier Ltd

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