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.

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

Cancer Research UK Clinical Trials Unit Leeds Institute of Clinical Trial Research University of Leeds Leeds UK

Clinic of Hematology University Clinical Center of Serbia Faculty of Medicine University of Belgrade Belgrade Serbia

Department of Clinical Therapeutics School of Medicine National and Kapodistrian University of Athens Athens Greece

Department of Hemato Oncology University Hospital Ostrava and Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Hematology Amsterdam UMC VU University Amsterdam Netherlands

Department of Hematology Ankara University Ankara Türkiye

Department of Hematology CHU de Liège Liège Belgium

Department of Hematology Oncology and Stem Cell Transplantation Clinical Cancer Research Group Universitätsklinikum Freiburg Freiburg Germany

Department of Hematology University Hospital of Nantes Nantes France

Department of Internal Medicine University Hospital Würzburg Germany

Department of Medicine Clinic Ottakring Wilhelminen Cancer Research Institute Vienna Austria

Department of Oncology and Hematology Kantonsspital St Gallen St Gallen Switzerland

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

Division of Hematology University of Leuven Leuven Belgium

Erasmus MC Cancer Institute and Erasmus University of Rotterdam Rotterdam Netherlands

Hospital Universitario de Salamanca Instituto de Investigación Biomédica de Salamanca Centro de Investigación del Cancer Salamanca Spain

IRCCS Azienda Ospedaliero Universitaria di Bologna SeràgnoliIstituto di Ematologia Dipartimento di Medicina Specialistica Diagnostica e Sperimentale Università di Bologna Bologna Italy

Myeloma Unit Division of Hematology University of Torino Azienda Ospedaliero Universitaria Città della Salute e della Scienza Torino Italy

Oslo Myeloma Center Department of Hematology Oslo University Hospital Oslo Norway; KG Jebsen Center for B Cell Malignancies University of Oslo Oslo Norway

Universitätsklinikum Hamburg Eppendorf Medizinische Klinik und Poliklinik Hamburg Germany

University College London Cancer Institute London UK

References provided by Crossref.org

EHA-EMN Evidence-Based Guidelines for diagnosis, treatment and follow-up of patients with multiple myeloma

Detection of early relapse in multiple myeloma patients