Abstract
Background:
T-cell redirecting bispecific antibodies have emerged as a highly effective, off-the-shelf treatment for the sequential management of different hematologic cancers. Bispecific T-cell antibodies targeting CD20, BCMA, and GPRC5D have established roles in relapsed/refractory (RR) diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and multiple myeloma (MM), particularly for patients progressing on therapy who are unable to wait for or do not have access to CAR-T therapy. Community-based professionals are uniquely positioned to provide access to off-the-shelf immunotherapy but need to be prepared to address logistical complexities (eg, navigating inpatient/outpatient considerations during step-up dosing [SUD]) and unique safety aspects (Crombie J et al. Blood. 2024;143:1565-1575; Sandahl TB et al. ASH 2024. Abstract 5047). We developed local/regional educational interventions tied to a larger initiative designed to assess and improve the community healthcare team's preparedness for implementing care with bispecific antibodies in NHL and MM.
Methods: The interprofessional initiative consisted of 15 virtual workshops conducted in collaboration with a large national network of oncology practices in the United States, including six sessions each focused on the healthcare team's role in integrating bispecific T-cell engagers (TCEs) into NHL and MM care, respectively, and three sessions covering both topics tailored to oncology nurses. Meetings were structured around real-world clinical scenarios and included discussions on therapeutic decision-making, sequencing, and operational challenges related to bispecifics. Baseline experience, practice preparedness, and care coordination capabilities were assessed via learner data, polling, and qualitative inputs. To date, 12 of the 15 sessions have been completed, and 202 learners, including 48 hematologist-oncologists, 20 nurse practitioners, and 95 oncology nurses, have participated across all sessions. An additional cohort of community-based professionals has been invited to participate in a companion online enduring activity.
Results: Pre-activity polling revealed that 64% of hematologist-oncologists and 67% of nurses reported either no or limited experience with bispecific antibodies. Regarding outpatient preparedness, 50% of hematologist-oncologists and 55% of nurses reported delivering bispecifics in practice, while the remainder indicated that they were in the planning phase or uncertain about implementation in the outpatient setting. The interventions appeared to successfully address preparedness; post education, learners showed a greater willingness to collaborate with multidisciplinary team (MDT) colleagues when navigating SUD considerations (33% improvement; P < .05) and improvements in preparation to implement strategies supporting outpatient TCE administration, such as use of appropriate monitoring tools, outreach to MDT colleagues, and provision of patient and staff education (32% improvement; P < .05).
Qualitative data from the interprofessional meetings identified the most commonly encountered clinical challenges raised by learners (N = 98): logistical rollout of SUD (21%), particularly regarding inpatient capacity and outpatient transition; need for frequent adaptation of dosing and use of adverse event (AE) mitigation approaches (18%); and uncertainty over sequencing of TCEs after CAR-T or prior TCE therapy (14%). Many cited a lack of progress in operationalizing TCE delivery, leading to fears over missed opportunities to provide patients with access to bispecifics.
Conclusions: While a subset of community practices were successfully delivering bispecific antibody therapy, many remained in an early or transitional phase of operationalizing off-the-shelf T-cell redirecting therapy. Community clinicians acknowledged that limited capacity to deliver bispecifics may compromise continuity and quality of care. Challenges identified included the logistics of therapy initiation (especially SUD protocols) and the need for coordination during the transition to therapeutic dosing. Interpersonal education—informed by real-world practice concerns—can support the development of intra-clinic protocols for delivering TCE therapy, raise awareness of supporting evidence, and help clinicians build strategic and operational infrastructures needed to increase access to bispecific antibodies in a safe and equitable manner.
