Supportive care for talquetamab-related dysgeusia in multiple myeloma: mixed-methods evidence, nutrition-focused flowchart, and digital companion concept

PURPOSE: Talquetamab (TAL) frequently induces a distinctive dysgeusia that diminishes eating enjoyment, oral intake, and quality of life in patients with multiple myeloma (MM). Patient-centered, evidence-based nutritional guidance tailored to TAL-related sensory phenotypes is scarce. This mixed-methods study aimed to characterize patient experiences, identify preferred dietary adaptations, and translate these findings into a proposed exploratory clinical workflow and a digital companion support concept for future validation. METHODS: A prospective, single-center exploratory mixed-methods study was conducted in talquetamab-treated patients with multiple myeloma who reported new-onset taste change (n = 25). Patient-reported dysgeusia, xerostomia symptoms, dietary experiences, and coping strategies were captured using a structured questionnaire with free-text fields. Taste change and xerostomia were assessed by patient report; objective psychophysical taste testing and sialometry were not performed in this cohort. Free-text responses were analyzed by two independent coders using reflexive thematic analysis with iterative consensus. Quantitative data were summarized descriptively. Integrated findings were translated in interprofessional focus groups into two exploratory supportive-care outputs: a proposed clinical workflow and a digital companion blueprint for future validation. RESULTS: Patients described heterogeneous and individualized taste disturbances, including reduced or unpleasant perception of sweet flavors, bitter/sour aversions, spice-related mucosal sensitivity, and reduced enjoyment of meals. Patient-reported xerostomia symptoms aggravated intolerance to dry or fibrous foods and impaired swallowing comfort. Frequently reported coping strategies included mild herbs and aroma cues, umami-rich additions, sauce- or soup-based texture modification, temperature and plating adjustments, saliva-supportive measures, and environmental or behavioral strategies. Based on these findings, we developed an exploratory supportive-care workflow incorporating cycle-based symptom screening, prospective use of validated taste assessment where feasible, structured xerostomia and nutritional-risk assessment, phenotype-oriented dietary suggestions, safety escalation, and follow-up. A digital companion blueprint (GUSTABOR) was conceptualized to support future individualized dietary guidance after usability and effectiveness testing. CONCLUSIONS: Talquetamab-related dysgeusia is clinically meaningful, heterogeneous, and closely linked to oral dryness symptoms, food texture tolerance, eating enjoyment, and social participation. The proposed workflow and digital companion blueprint should be interpreted as exploratory supportive-care concepts derived from patient-reported experience, not as validated clinical tools. Prospective multicenter studies using validated taste instruments, objective salivary-flow assessment, nutritional endpoints, and implementation outcomes are required before routine clinical adoption. IMPLICATIONS FOR CANCER SURVIVORS: Structured symptom screening, validated taste assessment where feasible, and individualized nutrition support may help identify patients at risk for reduced intake, weight loss, and impaired quality of life during talquetamab therapy. Digital support could broaden access to tailored guidance, but should be implemented only after prospective evaluation of usability, safety, resource requirements, and clinical benefit.