Practical Management of Bispecific Antibodies in Multiple Myeloma

The treatment landscape for relapsed/refractory multiple myeloma has been transformed by the approval of T-cell-redirecting bispecific antibodies (BsAbs) targeting B-cell maturation antigen (teclistamab, elranatamab, and linvoseltamab) and GPRC5D (talquetamab). Although pivotal trials have demonstrated deep and durable responses, the rapid transition of these off-the-shelf agents from controlled clinical settings to routine oncologic practice presents significant operational and clinical challenges. This review focuses on the practical framework required to deliver BsAb therapy safely and effectively across academic and community settings. We address critical components of patient selection and effective implementation strategies, including infrastructure for the management of unique short-term toxicities such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, and long-term infection risks. We discuss models for outpatient implementation of these agents including the use of technology and academic-community partnerships (shared care models). As BsAbs move into earlier lines of therapy and combination regimens, optimizing these practical management strategies is essential to ensuring equitable access and maximizing long-term outcomes for patients with multiple myeloma.