KEY TAKEAWAYS
- This study provided nurses with guidelines for handling CRS in pts treated with teclistamab, based on MajesTEC-1 findings.
- The study suggested that nurses need clear guidelines for identifying, monitoring, and treating CRS to administer teclistamab effectively.
Cytokine release syndrome (CRS) is a typical systemic inflammatory reaction seen with T-cell engagers. The MajesTEC-1 study explored teclistamab, the sole BCMA×CD3 bispecific antibody with a personalized, weight-based, and adaptable dosing regimen for treating triple-class exposed relapsed/refractory multiple myeloma.
A study mitigated CRS through pre-medication, incremental dosing, and timely identification and intervention. Nurses play a vital role in patient care, and their ability to quickly identify and treat CRS is essential for minimizing the risk of severe complications. Researchers aimed to equip nurses with the necessary tools for diagnosing, monitoring, and managing CRS in patients (pts) undergoing teclistamab treatment, drawing from the findings of the MajesTEC-1 study.
To minimize the risk of severe CRS, a graduated dosing regimen was employed, starting with 0.06 and 0.3 mg/kg step-up doses before administering the initial treatment dose of 1.5 mg/kg of subcutaneous teclistamab. Premedication included a corticosteroid, a histamine-1 receptor antagonist, and an antipyretic. Inpatient nursing staff performed regular vital sign checks every 2–4 hours, according to institutional protocols, to monitor for signs of CRS.
The approach to managing CRS varies depending on its severity. It included treatments such as tocilizumab (administered to 36.4% of pts), intravenous fluids (13.9%), low-flow oxygen (12.7%), corticosteroids (8.5%), single vasopressor administration (0.6%), and other supportive care options like antipyretics.
In the study, 72.1% of pts experienced CRS, which was generally of low severity; only one patient had a grade 3 event, and that was in the context of an infection. Most CRS cases (96.6%) occurred during the step-up dosing phase, emphasizing the importance of vigilant monitoring during this time. As symptoms like fever, hypoxia, chills, and hypotension can be indicative of other conditions as well, a thorough differential diagnosis is crucial.
Monitoring for CRS was primarily conducted inpatient, with vital signs being checked either frequently (every 2-4 hours) or continuously via wearable devices. Collaboration between pts, physicians, and nursing staff for early symptom recognition facilitated quick intervention, including transfer to intensive care units when needed. Since infections can worsen CRS, pts were screened for infections before starting teclistamab treatment. Regarding management, tocilizumab was an option for treating grade 1 CRS and recommended for grade 2 events, resulting in no recurrent CRS among pts.
The study showed that nurses require actionable recommendations for identifying, tracking, and responding to CRS to facilitate the effective delivery of teclistamab treatment.
Clinical Trial: https://classic.clinicaltrials.gov/ct2/show/NCT04557098/
Catamero, D. NSP-05: Managing Cytokine Release Syndrome in Relapsed/Refractory Multiple Myeloma: Experience With Teclistamab in the MajesTEC-1 Study.
