Bispecific monoclonal antibodies for the treatment of relapsed/ refractory multiple myeloma: expert recomendations for their administration in Spanish centers

Bispecific antibodies (BsAbs) have emerged as a novel therapeutic option for optimizing the treatment of patients with relapsed/refractory multiple myeloma (MM), due to their efficacy in this subset of patients, which suggests an increase in their use in the upcoming years. Their safety profile requires appropriate training for their clinical use. This expert consensus outlines the minimum requirements that should be considered for the safe integration of BsAbs into the therapeutic arsenal of Spanish hospitals. The presence of an intensive care unit, the availability of tocilizumab, and adequate training of on-site healthcare professionals are essential requirements for the administration of BsAbs. Furthermore, the establishment of rapid-response healthcare circuits for patients receiving BsAbs could help prevent serious adverse events, optimizing patient management. In healthcare centers lacking these requirements, it would be advisable to establish agreements and protocols for referring patients to specialized hospitals for the safe administration of initial doses (step-up phase), while long-term follow-up may be conducted at any center equipped to manage MM patients. The use of prophylactic measures is crucial to prevent/significantly reduce the incidence of adverse events. In the future, the incorporation of preventive strategies and a deeper understanding of BsAb-associated toxicities may facilitate their outpatient administration.