Can teclistamab be safely administered in the community? A single-center experience.

Abstract

e19502 Background: Majority of patients with multiple myeloma are treated in community settings. Teclistamab, a highly effective bispecific T-cell engager (BiTE), was approved for the treatment of relapsed refractory multiple myeloma but has the potentially lethal toxicity of cytokine release syndrome (CRS). Due to the risk of CRS, pharmacies/providers must be REMS-certified prior to prescribing treatment. CRS most commonly occurs after the 1st 3 doses with a median onset time of 2 days. The hospitals most comfortable administering and monitoring for BiTE toxicities are typically transplant/cellular therapy centers. Patients are hospitalized for 48 hours following the administration of first 3 doses. Subsequent outpatient treatment typically continues at these centers as well, limiting patient access to highly effective treatment. Whether teclistamab can safely be given in non-rapid response community infusion centers (CIC) with a less vigorous monitoring schedule is unknown. We established a monitoring guide to expand teclistamab accessibility to 18 (CIC) in our network. Methods: At AHN, a monitoring guide was devised for teclistamab (Table) based on existing safety data regarding the incidence and timing of CRS. Patients would be admitted for the 1st 3 doses and monitored for 48 hours after each dose. Starting with the 4th dose, teclistamab administration at CIC with no additional monitoring would be allowed if there were no CRS events with the immediately preceding dose. If the patient experienced a CRS event with the immediately preceding dose, the patient would be monitored for 1 hour until a dose was tolerated with no subsequent CRS events. Nursing and pharmacist education was arranged for all CIC regarding CRS identification and management. All CIC pharmacies were prospectively enrolled in the teclistamab REMS program at the time education was deployed. Prescribing providers were REMS certified as well. Results: Between 1/2023 and 1/2024, a total of 8 patients were treated at 6 CIC within AHN. Of those 6 centers, 3 were non-rapid response CIC. Out of the eight patients treated at local infusion centers, starting with the fourth teclistamab dose, none experienced CRS events. No additional safety occurred, and no patients were subsequently hospitalized for teclistamab toxicities. Conclusions: Teclistamab can be safely administered at CIC, including centers without rapid response capabilities, starting with the 4th dose after prior ramp-up administration. Post-injection monitoring may be reduced without increased incidence of CRS-related toxicities. Our monitoring guide may serve as a model for the safe administration of teclistamab and other BiTEs in CIC. [Table: see text]