Dr Mohan on Toxicities Associated With T-cell–directed Therapy in Myeloma

Meera Mohan, MD, MS, FACP, assistant professor, Department of Medicine, Division of Hematology, Medical College of Wisconsin, medical oncologist, Froedtert Hospital, discusses the toxicities associated with T-cell–directed therapies in relapsed/refractory multiple myeloma.

The emergence of the CAR T-cell therapies and bispecific antibodies have led to improved responses in later lines of treatment for patients with relapsed/refractory multiple myeloma. However, these new therapies have also led to the introduction of novel toxicities for these patients, and these adverse effects (AEs) require specific management, Mohan begins. Some of the primary toxicities associated with T cell–directed therapy are cytokine release syndrome (CRS), immune effector cell–associated neurotoxicity syndrome (ICANS), and other AEs including cytopenias, infections, and hypogammaglobulinemia, Mohan notes.

As these T-cell–directed therapies gain more prevalence in later lines of therapy and are potentially moved into earlier lines of treatment, it is important to understand how these toxicities affect patients, Mohan continues. Since patients with multiple myeloma are generally older, managing these AEs is necessary, given that these patients could be frail or have comorbidities, Mohan expands.

For example, when a patient who is frail and older experiences CRS, it is important act early, even in the event of low-grade toxicity, she says. Tocilizumab (Actemra) could be administered to mitigate the effects of CRS for these patients, Mohan concludes.