Addressing Challenges to Bispecific Integration Across Practice Settings in MM

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Successful bispecific antibody integration requires early collaboration between academic centers and community practices, particularly for patients with 4 or more prior therapies showing disease progression. The optimal model involves academic centers managing initial step-up dosing through specialized outpatient programs, then transferring ongoing care to community providers with continued consultation support. This approach leverages academic expertise for complex initiation procedures, while enabling convenient long-term care closer to patients' homes.

Educational initiatives represent critical success factors, addressing misconceptions about bispecific antibody toxicity profiles compared with CAR T-cell therapy. While both treatments can cause cytokine release syndrome and neurotoxicity, bispecific antibodies offer more controlled dosing environments with generally less severe complications. Academic centers have implemented comprehensive education programs, including on-site talks, nurse education sessions, and informal consultation opportunities, to build community provider confidence and competence.

The long-term vision involves community practices independently managing bispecific antibody step-up dosing as experience and comfort levels increase. This evolution is essential given the expanding FDA approvals for bispecific antibodies across hematologic malignancies and solid tumors. Success depends on standardizing best practices for cytokine release syndrome and neurotoxicity management, developing robust prophylactic protocols, and ensuring rapid access to expert consultation when needed. The transition to community-based care will significantly expand patient access to these effective therapies.