Real-world evaluation of teclistamab for the treatment of relapsed/refractory multiple myeloma (RRMM): an International Myeloma Working Group Study - Scorecard - MDSpire
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Real-world evaluation of teclistamab for the treatment of relapsed/refractory multiple myeloma (RRMM): an International Myeloma Working Group Study
Clinical Scorecard: Assessment of Teclistamab in Real-World Settings for Patients with Relapsed/Refractory Multiple Myeloma: Findings from an International Myeloma Working Group Investigation
At a Glance
Category
Detail
Condition
Relapsed/Refractory Multiple Myeloma (RRMM)
Key Mechanisms
Teclistamab is a BCMAxCD3 bispecific antibody targeting B-cell maturation antigen and CD3 to engage T cells against myeloma cells
Target Population
Triple-class-exposed patients with RRMM, including heavily pretreated and high-risk subgroups
Care Setting
International academic centers with real-world clinical practice outside clinical trials
Key Highlights
Teclistamab demonstrated a 67% overall response rate (ORR) in a diverse real-world RRMM cohort, including patients ineligible for pivotal trials.
Common adverse events include cytokine release syndrome (CRS) mostly grade ≤2, immune effector cell-associated neurotoxicity syndrome (ICANS), and high rates of infections.
Real-world patients were heavily pretreated (median 6 prior lines), with 83% triple-class refractory and 44% penta-drug refractory; 71% would not meet MajesTEC-1 trial eligibility.
Guideline-Based Recommendations
Diagnosis
Assess RRMM status and prior treatment exposures including BCMA-directed therapies.
Evaluate cytogenetic risk abnormalities and extramedullary disease presence.
Use IMWG consensus criteria for response assessment.
Management
Administer teclistamab per FDA/EMA approved label and institutional protocols.
Monitor and manage CRS and ICANS using ASTCT criteria; most events are low grade and reversible.
Implement antimicrobial prophylaxis and supportive care tailored to patient risk and institutional guidelines.
Monitoring & Follow-up
Regularly assess for infections, cytopenias, CRS, and neurotoxicity.
Monitor immunoglobulin G (IgG) levels due to risk of hypogammaglobulinemia.
Use CTCAE v5.0 for grading adverse events outside CRS/ICANS.
Risks
High incidence of infections including grade 3/4 and opportunistic infections; infection-related mortality reported.
CRS occurs in over 70% of patients but is mostly low grade and manageable.
Potential for neurotoxicity (ICANS), generally low grade and reversible.
Patient & Prescribing Data
210 patients with RRMM treated at 9 international centers; median age 67 years; heavily pretreated with median 6 prior lines; 71% ineligible for MajesTEC-1 trial criteria.
Teclistamab shows efficacy with 67% ORR in real-world settings including patients with prior BCMA therapies and high-risk features; adverse events manageable with appropriate monitoring.
Clinical Best Practices
Careful patient selection and baseline assessment including renal function, cytogenetics, and performance status.
Close monitoring for CRS and ICANS with prompt intervention per established guidelines.
Proactive infection surveillance and management given high infection rates.
Consider dose modifications and supportive care individualized to patient tolerance and toxicity profile.
Use standardized response criteria and regular follow-up to assess treatment efficacy.
by Carlyn Rose Tan, Sireesha Asoori, Chiung-Yu Huang, Larissa Brunaldi, Rakesh Popat, Efstathios Kastritis, Joaquin Martinez-Lopez, Radhika Bansal, Andre De Menezes Silva Corraes, Saurabh Chhabra, Ricardo Parrondo, Sikander Ailawadhi, Despina Fotiou, Meletios A. Dimopoulos, Kwee Yong, Catriona Mactier, Chris Lau, Magdalena Corona, Adolfo Jesús Sáez Marin, Hira Mian, Brian GM. Durie, Saad Z. Usmani, Thomas G. Martin, Yi Lin
