Tocilizumab Prophylaxis for Patients with Multiple Myeloma Treated with Bispecific Antibodies Open Access

• Without compromising efficacy, a single dose of prophylactic tocilizumab resulted in low rates of CRS (10.1%) and ICANS (5.9%).

• It decreases resource utilization, increases patient experience and supports investigation of outpatient step-up dosing.

Bispecific antibodies for treatment for multiple myeloma are highly effective but commonly cause cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Emerging data indicate that prophylactic tocilizumab may reduce CRS, without impacting efficacy. We administered a single dose of tocilizumab prior to the first dose of bispecific antibodies to 119 patients to determine the impact on CRS in a real-world setting including BCMAxCD3- and GPRC5DxCD3-targeted antibodies. The best overall response rate (ORR) was 65.7% (binomial 95%CI: 55.8%-74.7%). We observed a low overall rate of CRS (10.1%: 5.3%-17%). For teclistamab, elranatamab, linvoseltamab and talquetamab individually, the CRS rate was 8.9%, 12.5%, 0%, and 13%. The overall ICANS (5.9%: 2.4%-11.7%) was low, but similar to rates without prophylactic tocilizumab. CRS was limited to grade 1 for 10 of 12 events. There were no grade 3 CRS events, and no additional doses of tocilizumab or corticosteroids were given for CRS. Our real-world evidence results suggest that tocilizumab may be effective as a preventative, rather than reactive, measure to prevent CRS without compromising efficacy.