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.
Ludwig, Heinz; Terpos, Evangelos; van de Donk, Nielset al.
2023 • In The Lancet Oncology, 24 (6), p. 255 - e269
[en] 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.
Disciplines :
Hematology
Author, co-author :
Ludwig, Heinz; Department of Medicine, Clinic Ottakring, Wilhelminen Cancer Research Institute, Vienna, Austria. Electronic address: heinz.ludwig@extern.gesundheitsverbund.at
Terpos, Evangelos; Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
van de Donk, Niels; Department of Hematology, Amsterdam UMC, VU University, Amsterdam, Netherlands
Mateos, Maria-Victoria; Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cancer, Salamanca, Spain
Moreau, Philippe; Department of Hematology, University Hospital of Nantes, Nantes, France
Dimopoulos, Melitios-Athanasios; Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Delforge, Michel; Division of Hematology, University of Leuven, Leuven, Belgium
Rodriguez-Otero, Paula; Cancer Center Clinica Universidad de Navarra, Pamplona, Spain, Centro de Investigación Medica Aplicada, Pamplona, Spain, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain, Centro de investigación biomédica en red de Oncologia, Pamplona, Spain
San-Miguel, Jesús; Cancer Center Clinica Universidad de Navarra, Pamplona, Spain, Centro de Investigación Medica Aplicada, Pamplona, Spain, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain, Centro de investigación biomédica en red de Oncologia, Pamplona, Spain
Yong, Kwee; University College London Cancer Institute, London, UK
Gay, Francesca; Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
Einsele, Hermann; Department of Internal Medicine, University Hospital Würzburg, Germany
Mina, Roberto; Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
Caers, Jo ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'hématologie clinique
Driessen, Christoph; Department of Oncology and Hematology, Kantonsspital St Gallen, St Gallen, Switzerland
Musto, Pellegrino; Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University School of Medicine, Bari, Italy, Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari, Italy
Zweegman, Sonja; Department of Hematology, Amsterdam UMC, VU University, Amsterdam, Netherlands
Engelhardt, Monika; Department of Hematology, Oncology and Stem Cell Transplantation, Clinical Cancer Research Group, Universitätsklinikum Freiburg, Freiburg, Germany
Cook, Gordon; Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trial Research, University of Leeds, Leeds, UK
Weisel, Katja; Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik und Poliklinik, Hamburg, Germany
Broijl, Annemiek; Erasmus MC Cancer Institute & Erasmus University of Rotterdam, Rotterdam, Netherlands
Beksac, Meral; Department of Hematology, Ankara University, Ankara, Türkiye
Bila, Jelena; Clinic of Hematology, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Schjesvold, Fredrik; Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway, KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
Cavo, Michele; IRCCS Azienda Ospedaliero-Universitaria di Bologna, SeràgnoliIstituto di Ematologia, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
Hajek, Roman; Department of Hemato-Oncology, University Hospital Ostrava & Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
Touzeau, Cyrille; Department of Hematology, University Hospital of Nantes, Nantes, France
Boccadoro, Mario; Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
Sonneveld, Pieter; Erasmus MC Cancer Institute & Erasmus University of Rotterdam, Rotterdam, Netherlands
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