{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T20:58:33Z","timestamp":1781211513332,"version":"3.54.1"},"reference-count":69,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am Soc Clin Oncol Educ Book"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>Bispecific antibodies (BsAb) are a class of T-cell\u2013redirecting therapies used in a variety of advanced malignancies. BsAb can be associated with clinically significant toxicities, including cytokine release syndrome (CRS), immune effector cell\u2013associated neurotoxicity syndrome (ICANS), and infections. CRS occurs in up to two thirds of patients and can be associated with ICANS in rare cases. CRS is best treated with tocilizumab, while glucocorticoids are effective in treating both. BsAb-associated CRS and ICANS are mostly low-grade and are confined to the step-up and first full doses. However, the risk of infection persists throughout BsAb therapy and is the leading cause of nonrelapse mortality, particularly with B-cell maturation antigen (BCMA)\u2013targeting BsAbs, due to profound B-cell and plasma cell depletion, resulting in near-universal hypogammaglobulinemia. Infection risk is also increased due to cytopenias, neutropenia and lymphopenia, occurring during the first 6 months of BsAb therapy. Current infection prophylaxis guidelines recommend universal herpes simplex virus, varicella zoster virus, and Pneumocystis jirovecii pneumonia prophylaxis, with primary intravenous immunoglobulin prophylaxis strongly recommended for BCMA-targeting BsAbs. A few other acute toxicities associated with BsAbs include infusion-related reactions generally noted very early (&lt;6 hours) from start of the infusion, and tumor flare reactions usually occurring during the first BsAb cycle. A few important toxicities have been noted with bispecific constructs targeting GPRC5D, including alternation of taste, unintentional weight loss, rash, and nonrash skin and nail toxicities significantly affecting patient's quality of life. A few late but rare complications include progressive multifocal leukoencephalopathy and second primary malignancies, which require continued vigilance. As the use and number of BsAb continues to grow, the knowledge of the characteristics, timing, and management of BsAb toxicities is essential to current clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/edbk-26-517460","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T19:59:08Z","timestamp":1781207948000},"source":"Crossref","is-referenced-by-count":0,"title":["Management of Bispecific Antibody Toxicities: A Focus on Multiple Myeloma"],"prefix":"10.1200","volume":"46","author":[{"given":"Eden","family":"Biltibo","sequence":"first","affiliation":[{"name":"Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajshekhar","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Multiple Myeloma and Amyloidosis Program, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3979-9273","authenticated-orcid":false,"given":"Michael R.","family":"Bishop","sequence":"additional","affiliation":[{"name":"The David and Etta Jonas Center for Cellular Therapy, Chicago, IL"},{"name":"Hematopoietic Cellular Therapy Program, University of Chicago, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1609783"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2203478"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-023-02528-9"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2204591"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.24.01008"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(22)00335-7"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2206913"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.01725"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40425-018-0343-9"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-22-3667"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22147652"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-021-00547-6"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2018.12.758"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2514663"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2024-206003"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(24)00385-5"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2025029360"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2514752"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2025-100"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.16_suppl.7504"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.24.01008"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.16_suppl.7510"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.16_suppl.7513"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(24)00043-3"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2024-203426"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2025-248"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2025-2210"},{"key":"e_1_3_2_29_2","article-title":"MM-216: Prophylactic tocilizumab to mitigate cytokine release syndrome and outpatient dosing of talquetamab in relapsed\/refractory multiple myeloma: Updated phase 1\/2 Monumental-1 results","volume":"25","author":"Schinke C","year":"2025","unstructured":"Schinke C, Vij R, Jagannath S, et al: MM-216: Prophylactic tocilizumab to mitigate cytokine release syndrome and outpatient dosing of talquetamab in relapsed\/refractory multiple myeloma: Updated phase 1\/2 Monumental-1 results. Clin Lymphoma Myeloma Leuk 25, 2025 (suppl 1; abstr S908)","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.16_suppl.e19537"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-025-01222-y"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1630146"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","unstructured":"Rahbari KJ Mijares RDT Kennedy K et al: Outpatient administration of bispecific antibody therapy for hematologic malignancies: A practical guide. JCO Oncol Pract 10.1200\/OP-25-00652 [epub ahead of print on December 4 2025]","DOI":"10.1200\/OP-25-00652"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-94353-0_27"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-024-00905-y"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ymthe.2025.03.048"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-025-01386-7"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2025029572"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.16_suppl.7527"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1158\/2643-3230.BCD-23-0049"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2023011658"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2025-5757"},{"key":"e_1_3_2_43_2","unstructured":"Johnson&Johnson Medical Connect. TECVAYLI (teclistamab-cqyv). Medical Information; https:\/\/www.jnjmedicalconnect.com\/products\/tecvayli\/medical-content\/tecvayli-impact-of-primary-immunoglobulin-prophylaxis-on-infections."},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35107"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2024013461"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2024.42.16_suppl.7540"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1002\/hem3.136"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2025.11.004"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(24)00385-5"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2022-157988"},{"key":"e_1_3_2_51_2","doi-asserted-by":"crossref","DOI":"10.1182\/blood-2024-199542","article-title":"Cevostamab in patients with heavily pretreated relapsed\/refractory multiple myeloma (RRMM): Updated results from an ongoing phase i study demonstrate clinically meaningful activity and manageable safety and inform the doses and regimen for combination studies","volume":"144","author":"Richter J","year":"2024","unstructured":"Richter J, Thomas SK, Krishnan AY, et al: Cevostamab in patients with heavily pretreated relapsed\/refractory multiple myeloma (RRMM): Updated results from an ongoing phase i study demonstrate clinically meaningful activity and manageable safety and inform the doses and regimen for combination studies. Blood 144, 2024 (suppl 1; abstr 1021)","journal-title":"Blood"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2023.283590"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-025-01282-0"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2025-5814"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022015956"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2022-162709"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-024-01003-z"},{"key":"e_1_3_2_58_2","first-page":"1436","article-title":"Non-tuberculous mycobacterial infections following teclistamab in multiple myeloma","volume":"110","author":"Ho M","year":"2025","unstructured":"Ho M, Paruzzo L, Minehart J, et al: Non-tuberculous mycobacterial infections following teclistamab in multiple myeloma. Haematologica 110:1436-1442, 2025","journal-title":"Haematologica"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18909"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-023-00879-7"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2024.114075"},{"key":"e_1_3_2_62_2","first-page":"2368","article-title":"Phenomenon of tumor flare with talquetamab in a patient with extramedullary myeloma","volume":"109","author":"Forsberg M","year":"2024","unstructured":"Forsberg M, Beltran S, Goldfinger M, et al: Phenomenon of tumor flare with talquetamab in a patient with extramedullary myeloma. Haematologica 109:2368-2371, 2024","journal-title":"Haematologica"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.3960\/jslrt.25065"},{"key":"e_1_3_2_64_2","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol31050202"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.70116"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1080\/14796694.2025.2555170"},{"key":"e_1_3_2_67_2","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2024-011200"},{"key":"e_1_3_2_68_2","doi-asserted-by":"publisher","unstructured":"Zhou K Ebben L Dhakal B et al: Implementation of bispecific antibodies in the community: Lessons from the ThedaCare Cancer Center experience. JCO Oncol Pract 10.1200\/OP-25-00748 [epub ahead of print on January 13 2026]","DOI":"10.1200\/OP-25-00748"},{"key":"e_1_3_2_69_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO-25-00992"},{"key":"e_1_3_2_70_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO-25-01957"}],"container-title":["American Society of Clinical Oncology Educational Book"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/EDBK-26-517460","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T19:59:11Z","timestamp":1781207951000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/EDBK-26-517460"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":69,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1200\/EDBK-26-517460"],"URL":"https:\/\/doi.org\/10.1200\/edbk-26-517460","relation":{},"ISSN":["1548-8748","1548-8756"],"issn-type":[{"value":"1548-8748","type":"print"},{"value":"1548-8756","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"article-number":"e517460"}}