A Roadmap to Implementing Outpatient Administration of Bispecific Antibodies in Multiple Myeloma

Alfred L. Garfall¹Rahul Banerjee²Laurent Frenzel³Cyrus Khandanpour⁴Yi Lin⁵Erica Ottoni⁶Robert Rifkin⁷Sarah Rockwell⁸Cesar Rodriguez⁹Humberto Villefort¹⁰Elena Zamagni^11,12*

• ¹University of Pennsylvania, Philadelphia, PA, United States
• ²Fred Hutchinson Cancer Center, Seattle, WA, United States
• ³Department of Hematology, Hospital Necker, Paris, France
• ⁴Universitätsklinikum Münster, Münster, Germany, and University Hospital Schleswig-Holstein Campus Lübeck, University Cancer Center Schleswig-Holstein and University of Lübeck, Lübeck, Germany
• ⁵Mayo Clinic, Rochester, MN, United States
• ⁶Hospital Moinhos de Vento, Porto Alegre, Brazil
• ⁷Rocky Mountain Cancer Centers/US Oncology Research, Denver, CO, United States
• ⁸Florida Cancer Specialists & Research Institute, Tampa, FL, United States
• ⁹Icahn School of Medicine at Mount Sinai, New York, NY, United States
• ¹⁰A.C.Camargo Cancer Center, São Paulo, Brazil
• ¹¹IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
• ¹²Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy

INTRODUCTION: Bispecific antibodies (BsAbs) are novel immunotherapy agents for the treatment of relapsed/refractory multiple myeloma (RRMM). Currently, 3 BsAbs (teclistamab, talquetamab, and elranatamab) are approved for the treatment of RRMM. Administering BsAbs in different practice settings is crucial to improving treatment access and patient outcomes. This report provides actionable guidance to implement safe and effective administration of BsAbs for patients with RRMM in outpatient and community settings. METHODS: Three clinician advisory workshops were held in the United States, Europe, and Latin America to discuss key factors to operationalize BsAb use in outpatient and community settings, focusing on the critical phases of practice setup, treatment initiation, and ongoing management. RESULTS: BsAb administration in outpatient and community settings requires careful planning, a well-prepared multidisciplinary team (MDT) of healthcare professionals, and clear protocols, including MDT composition, roles/responsibilities, capacity planning, patient selection criteria, step-up dosing procedure, admission processes, patient/caregiver education requirements, and adverse event (AE) monitoring/management. Comprehensive MDT training on protocols and preparedness to manage AEs is essential. Patients initiating outpatient BsAb therapy should have a reliable caregiver, access to a hospital, controlled comorbidities, and no active infections. Ensuring patients and caregivers understand the benefits, risks, and expectations of BsAb therapy is vital for successful treatment and a positive patient experience. CONCLUSION: Administering BsAbs in outpatient and community settings can be done safely and effectively with appropriate planning and protocols. Enabling safe and effective BsAb administration in these settings is essential to ensure more patients with RRMM have access to treatment and improved outcomes.