4.7 Review

Management of Adverse Reactions for BCMA-Directed Therapy in Relapsed Multiple Myeloma: A Focused Review

Journal

JOURNAL OF CLINICAL MEDICINE
Volume 12, Issue 17, Pages -

Publisher

MDPI
DOI: 10.3390/jcm12175539

Keywords

BCMA; Bispecific antibodies; CAR-T cell therapy; relapsed multiple myeloma; BiTEs; ADCs

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Anti-B-cell maturation antigen therapies have shown promising results in relapsed refractory multiple myeloma, but severe side effects pose a risk to patients. This review focuses on the most common complications post-BCMA therapy, discussing risk factors, pathogenesis, clinical features, and prevention and treatment strategies. FDA-approved agents for adult RRMM patients were analyzed to outline stepwise management of complications.
Anti-B-cell maturation antigen therapies consisting of bispecific antibodies, antibody-drug conjugates, and chimeric antigen receptor T cells have shown promising results in relapsed refractory multiple myeloma (RRMM). However, the severe side effects include cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, cytopenia(s), infections, hemophagocytic lymphohistiocytosis, and organ toxicity, which could sometimes be life-threatening. This review focuses on these most common complications post-BCMA therapy. We discussed the risk factors, pathogenesis, clinical features associated with these complications, and how to prevent and treat them. We included four original studies for this focused review. All four agents (idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, belantamab mafodotin) have received FDA approval for adult RRMM patients. We went through the FDA access data packages of the approved agents to outline stepwise management of the complications for better patient outcomes.

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