Guido Lancman ^1,2* Kevin Song ³ Darrell White ⁴ Tina Crosbie ⁵ Ismail Sharif ⁶ Marianne Emond ⁷ Muhammad Saleem Raza ⁸ Martine Elias ⁹ Rayan Kaedbey ¹⁰ Michael P Chu ¹¹

• ¹ Icahn School of Medicine at Mount Sinai, New York, United States
• ² Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
• ³ Vancouver General Hospital, Vancouver, British Columbia, Canada
• ⁴ Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
• ⁵ The Ottawa Hospital, Ottawa, Ontario, Canada
• ⁶ Durham Region Cancer Centre, Oshawa, Canada
• ⁷ Centre Hospitalier Universitaire de Québec, Québec, Quebec, Canada
• ⁸ Dr. Everett Chalmers Regional Hospital, Fredericton, New Brunswick, Canada
• ⁹ Myeloma Canada, Dorval, Canada
• ¹⁰ Segal Cancer Centre, Montreal, Quebec, Canada
• ¹¹ Cross Cancer Institute, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

Background: T-cell-redirecting therapies, such as bispecific antibodies and chimeric antigen receptor T-cells, exploit the cytotoxic capabilities of the immune system to destroy cells expressing specific surface antigens, including malignant cells. These therapies have demonstrated unprecedented rates, depth, and duration of responses in relapsed and refractory multiple myeloma.However, there are significant challenges in implementing these therapies into practice, which require multidisciplinary and multicentre coordination and significant healthcare resources to effectively manage these patients. So far, there are no Canadian guidelines for the effective implementation and use of T-cell-redirecting therapies.This consensus statement was developed based on three advisory meetings held in March, July, and November 2023. During these meetings, a panel of Canadian subject matter experts and representation from Myeloma Canada gathered to discuss the optimal procedures for the use of Tcell-redirecting therapies in the treatment of multiple myeloma. Members of the panel performed a thorough review of randomized clinical trials, real-world data, and other current literature, and provided their up-to-date clinical experience with T-cell-redirecting therapies in Canadian practice settings. Subsequently, asynchronous working groups were appointed to develop unified criteria for patient selection, appraise referral pathways, and devise strategies for management of short-term and long-term adverse events arising from the use of T-cell-redirecting therapies in multiple myeloma.Results: Here, we present recommendations for optimizing patient selection, referral pathways, and adverse event management in the Canadian practice setting. These recommendations are relevant for hematologists/oncologists, oncology nurses, pharmacists, nurse practitioners, physician assistants, and other providers who treat patients with multiple myeloma, as well as individuals with multiple myeloma and their care partners. These recommendations will be of interest to clinicians who treat patients with MM at community clinics and hospitals and who may be interested in referring patients for T-cell-redirecting therapy.