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Reducing Toxicity Associated with Teclistamab: The Role of Prophylactic Tocilizumab and Timing for Immunoglobulin Replacement in a National Cohort Study
To evaluate the safety management of teclistamab treatment in Denmark, focusing on cytokine-release syndrome (CRS) prevention using prophylactic tocilizumab (Toci) and infection prophylaxis with immunoglobulin replacement therapy (IgRT).
Approach:
Study Design: A retrospective, academic, observational study analyzing consecutive patients receiving teclistamab for relapsed or refractory multiple myeloma from February 2024 to November 1, 2025.
Data Collection: Data were collected through chart reviews by trained specialists and entered into a REDCap database, validated for accuracy.
Patient Groups: Patients were divided into two groups: those receiving prophylactic Toci (PPxToci) and those not receiving it (NoPPxToci).
Key Findings:
CRS occurred in 69% of the NoPPxToci group versus 8% in the PPxToci group (p = 0.001).
Grade 2 CRS was reported in 29% of the NoPPxToci group compared to 2% in the PPxToci group.
No Grade ≥ 3 CRS events were observed in either group.
The median duration of CRS was shorter in the PPxToci group (1.5 days) compared to the NoPPxToci group (2 days).
Interpretation:
Prophylactic administration of tocilizumab significantly reduces the incidence of CRS in patients receiving teclistamab, potentially allowing for outpatient management.
Limitations:
The study is retrospective and observational, which may introduce biases.
Data collection was limited to a specific timeframe and geographic location.
Conclusion:
Prophylactic tocilizumab appears to effectively reduce CRS rates in patients treated with teclistamab, supporting its use in clinical practice.
by Astrid Hundebøll Torpe, Jonathan Thorsen, Gustav Mathiasen, Katrine Fladeland Iversen, Sarah Farmer, Thomas Lund, Charlotte Toftmann Hansen, Lene Kongsgaard Nielsen, Nicolai Grønne Dahlager Jørgensen, Maja Ølholm Vase, Elena Manuela Teodorescu, Morten Salomo, Christina Wennerström, Tobias S. Slørdahl, Agoston Gyula Szabo
