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    Cellular and T cell engager Immunotherapy

    Category: Cellular and T cell engager Immunotherapy

    Prophylactic Dexamethasone (dex) with Outpatient Step-Up Dosing (SUD) of Bispecific Antibodies (BsAb) in Multiple Myeloma (MM) v. Standard of Care (SOC) Inpatient Observation

    (PA-097) Prophylactic Dexamethasone (dex) with Outpatient Step-Up Dosing (SUD) of Bispecific Antibodies (BsAb) in Multiple Myeloma (MM) v. Standard of Care (SOC) Inpatient Observation

    Wednesday, September 17, 2025
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    Introduction: Teclistamab (tec) and talquetamab (tal) are BsAb therapies approved for MM. Due to the risk of CRS and ICANS, the prescribing information recommends hospitalization for 48 hours after each SUD. This can be challenging for patients (pts), increasing healthcare resource utilization (HCRU) and cost. Herein, we compare the cost and feasibility of outpt SUD using prophylactic dex and remote monitoring via Hospital at Home (HaH) at Levine Cancer Institute (LCI) to standard 48h inpt observation following each SUD at Wake Forest University. The aim was to reduce HCRU while maintaining safety.

    Methods: Pts at LCI received prophylactic dex 8 mg on the day after each SUD. On days between SUDs, pts were examined at home by Mobile Integrated Health worker who coordinated a virtual visit with a HaH internist and calculated their ICE score. Pts were provided a thermometer, blood pressure cuff, pulse oximeter, wearable monitor for heart and respiratory rate, and an electronic tablet to input vital signs every 4 hours. Pts had virtual access to HaH nursing staff 24/7. Grade 1 CRS was managed outpt with acetaminophen and additional doses of dex as needed, while persistent fever or higher grade CRS required evaluation at the hospital. Data related to safety outcomes, toxicity management, and HCRU were collected retrospectively for the 30-day period after starting a BsAb. Admission within 30 days was not counted towards HCRU if related to disease progression.

    Results: Outpatient SUD occurred for 32 LCI pts (16 tec, 16 tal) compared to 24 SOC pts (13 tec, 11 tal). The incidence of CRS was 59% for the LCI group (max grade [G] 1 41%, G2 19%) compared to 54% of the SOC group (G1 33%, G2 12.5%, G3 4%, G4 4%). Recurrent CRS with subsequent SUDs occurred in 32% of outpts and 46% of SOC pts. All observed ICANS was grade 1 and occurred in 6% of LCI pts v. 17% SOC. The mean dex dose per patient was 28.9 mg at LCI v. 3.3 mg for SOC. Tocilizumab use was significantly less for the LCI group with prophylactic dex (12.5% v. 42%; p = 0.03). The estimated total toci-related per patient cost was $868 in the LCI arm versus $2909 in the SOC arm. Hospitalization within the first 30 days occurred in 43.8% of the LCI pts, with a mean of 1.1 inpt days per patient v. 7.8 days for SOC. The mean estimated cost per patient was $6,444 in the LCI cohort vs. $29,911 in the SOC cohort. Overall, this represents a relative cost savings of 0.78, indicating a 78% reduction in cost for outpatient SUD versus inpatient observation.

    Conclusions:

    Oupt BsAb step-up dosing can be given safely. It resulted in a reduction of 6.7 hospital days per patient and was associated with a 78% reduction in estimated cost per patient compared to inpatient observation. While prophylactic dex did not reduce CRS incidence, it resulted in no grade 3 or 4 CRS events and less tocilizumab administration which contributed substantially to overall cost savings.