Outpatient bispecific T-cell engager therapy for multiple myeloma demands thorough patient and caregiver education, a regional clinical pharmacist at the American Oncology Network stated.
Nicole McMullin, who oversees clinical programs in the network, said early involvement before treatment starts is essential. Patients and caregivers need to learn how to track serious side effects at home.
Monitoring kits and hands-on training
At the network, patients get a kit with a blood pressure cuff, thermometer, and pulse oximeter. Before therapy begins, nurses or educators meet with them to go over common adverse effects. They describe symptoms of cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, then show how to use each device.
The team asks patients to demonstrate they can operate the tools. This step ensures both patients and caregivers are prepared for home monitoring. McMullin noted the process goes beyond distributing equipment—it aims to build confidence in using it.
A fever often signals the start of cytokine release syndrome. Patients are instructed to report it right away. When they call, nurses follow set procedures to evaluate the situation and decide what to do next.
Building a multidisciplinary team
For community oncology practices wanting to use outpatient step-up dosing, McMullin advised creating a dedicated team at each location. The group should include a physician leader, advanced practice providers, regional clinical pharmacists, in-clinic pharmacy staff, infusion nurses, and financial counselors.
Financial counselors help obtain insurance approvals for the therapy and for tocilizumab, a drug used to treat cytokine release syndrome. Without this help, patients could face delays or denials that might interrupt treatment.
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Clear procedures are vital. McMullin stressed the importance of defined roles, nurse triage documents, patient education plans, and staff training. These elements ensure consistency across clinics, particularly when handling complex cases.
The network has treated about 60 patients with this approach. Fewer than one in five developed cytokine release syndrome during step-up dosing, and all cases were mild, requiring no hospital stays.
Patients and families may feel uneasy about monitoring for serious side effects at home. The alternative—constant hospital observation—can be just as stressful. With proper preparation, many manage the process independently. The benefit of more freedom and less time in a clinic often makes the adjustment worthwhile.
Lessons for smaller practices
Smaller oncology practices might avoid outpatient bispecific therapy because of limited resources. McMullin recognized the difficulties but said the model can work on a smaller scale. The best approach is to begin with a core team and expand as needed.
The initial costs for training and equipment are high, but the long-term advantages—like fewer hospital visits and happier patients—can make it worthwhile. The network’s experience shows that with the right protocols, outpatient treatment is safe and effective.
Support from health divisions can also help practices implement these changes smoothly.