Hi, my name is Sridevi Rajeeve and I'm a multiple myeloma and cell therapy specialist at the Memorial Sloan-Kettering Cancer Center in New York City.
I'm here at ASH 2025, in Orlando, Florida, and we have an exciting project that we are discussing as opposed to a presentation later tonight, and that is looking at leveraging remote patient monitoring for the outpatient administration of bispecific antibodies in relapsed refractory multiple myeloma.
So, you know, just to provide context to the project that we are doing, bispecific antibodies like teclistamab, talquetamab, elranatamab.
And now linvoseltamab have really changed the landscape of relapsed refractory myeloma, in the sense that they are drugs that are providing deep and durable responses.
The way the drugs are administered is that there is an initial step up dosing until you reach the treatment dose, and for the step up dosing, there is a requirement that you be admitted to the hospital during that initial phase to monitor closely for two major side effects, number one being cytokine release syndrome,
which is a combination of fever, low blood pressure and low oxygen, and neurotoxicity, in which the patients can have confusion and agitation and, in worst case scenarios, seizures.
To avoid patients suffering at home, any of these complications, and then presenting to the hospital is why a lot of the earliest clinical trials, and therefore there is an FDA mandate based on the way the trials were done, that anyone who's getting these drugs should have the initial doses in the hospital, followed by outpatient administration.
As we treat more and more patients, we are now finding that while this model works.
In busy hospitals and every single hospital is busy, we are occupying patient beds by using these drugs for patients.
And however, there is a urgent need to declutter hospitals with patients just waiting around for one fever to happen over the course of seven days while patients are receiving this step of therapy.
So how can be safely do it effectively?
It needs a lot of resources if we are doing it without the assistance of probably wearable devices in terms of a monitoring team or nurses or staff that call patients every day.
But we thought of another way why don't we leverage the use of remote patient monitoring so that we can mimic the way vital signs are captured in the hospitals,
or even better, have a continuous capture of vital signs so that it can be seen in real time on a dashboard.
And the built an escalation pathway.
And these patients who are now triggering clinical alarms, can be brought to the hospital as and when needed.
With that, we designed a study which is now almost completing at Memorial Sloan Kettering,
in which we took patients getting teclistamab and talquetamab, some of the earliest bispecifics that were approved for multiple myeloma.
And we partnered with the company for remote patient monitoring.
And these patients were then completely treated outpatient for their bispecific therapy.
The patients would only come to the hospital for their doses on the intermediate days.
They were followed through telemedicine, and therefore patients were able to stay at home for the duration of their entire step of dosing,
which otherwise they would have been in the hospital for this particular abstract that we are presenting ASH 2025,
we looked at 14 different patients who got teclistamab or talquetamab with remote patient monitoring.
And what we saw was that patients were able to complete their outpatient monitoring 86% of times.
There were a couple of patients who we had to bring in inpatient for recurrent or persistent CRS, and they completed their dose in patients.
So that's a minority of the patients.
That's just 14% of patients.
And among that 14% of patients, there were two patients who were not able to complete their full step of dosing, one due to an adverse effect that went on for a month, which was AKI, and another patient who was not quite compliant.
So we had to, you know, negotiate and really not complete that step of dosing.
But 86% of patients completed their dosing outpatients successfully, right as we were implementing it, the NCCN guidelines changed
and we were able to incorporate tocilizumab, which is one of the drugs that we gave to mitigate, cytokine release syndrome.
And we were able to give that ahead of time for these patients.
We amended the protocol.
And what we found was that since we started giving tocilizumab before or at the time of the first dose,
none of those patients ended up having any fevers, of CRS.
And that's huge.
None of these patients had to have an unscheduled visit to our emergency room or need to be admitted.
So, you know, these are really interesting findings that are showing that two things.
One, with remote patient monitoring, you can have a clear look at how is the patient doing real time.
Build a protocol in which, if there's any need of the clinical escalation, these patients can be brought back.
And two, with the incorporation of tocilizumab earlier into bispecific antibodies, it's really not affecting efficacy,
and rather it's completely mitigating any of the side effects you can have.
And these patients are able to be treated completely in the outpatient setting.
I believe this could be what the future looks like.
You know, especially for community oncologists who are wonderful collaborators.
They refer their patients to us, and we do the step up dosing and transition back to them.
But maybe if their practices consider some form of remote patient monitoring or incorporating tocilizumab earlier as a prophylaxis,
these drugs can be given just as they would in their clinics, and really expand access even more to patients.
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