Pre-Treatment Assessment
- Patient Selection
- Consider factors such as age, performance status, and comorbidities to evaluate treatment tolerance. Patients with good performance status and no severe comorbidities are better candidates for T-cell-engaging bispecific antibody therapy.
- Disease Characteristics
- Define the stage of multiple myeloma, cytogenetic abnormalities, and gene mutations to predict treatment response and guide personalized regimens. For example, patients with high-risk cytogenetic abnormalities may require more aggressive strategies.
Treatment Process Management
- Dose Adjustment
- Individualize doses of T-cell-engaging bispecific antibodies based on patient response and tolerance. Start with the recommended initial dose, then titrate under physician guidance, considering adverse effects and efficacy.
- Combination Therapy
- Combine bispecific antibodies with other anti-myeloma agents (e.g., proteasome inhibitors, immunomodulatory drugs, corticosteroids) to enhance efficacy. Monitor drug interactions and adverse events.
Adverse Event Management
- Cytokine Release Syndrome (CRS)
- Most cases are grade 1–2. Diagnosis involves medical history review, physical exams, and lab tests. Prophylactic tocilizumab may reduce incidence. Manage severity with observation, tocilizumab, or corticosteroids.
- Neurotoxicity
- Includes headaches, immune effector cell-associated neurotoxicity syndrome (ICANS), and peripheral neuropathy. Incidence varies by bispecific antibody.
- Evaluate with neurological exams and diagnostic tests. Use dexamethasone as first-line therapy for ICANS; prophylactic non-sedating antiepileptics may be considered. Consult neurologists for persistent cases.
Post-Treatment Monitoring
- Efficacy Evaluation
- Regularly assess tumor response via imaging (e.g., PET-CT, MRI) and serological tests (e.g., serum protein electrophoresis) to guide treatment adjustments.
- Long-Term Follow-Up
- Monitor quality of life, long-term adverse effects, immune function (to prevent infections), and psychological status. Provide psychological support as needed.
Role of IMWG
The International Myeloma Working Group (IMWG) is collecting prospective real-world data from patients receiving immunotherapies to refine clinical practices and optimize management strategies.
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