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REVIEW article

Front. Oncol.
Sec. Hematologic Malignancies
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1446995

Recommendations for the Effective Use of T-Cell-Redirecting Therapies: A Canadian Consensus Statement

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

The final, formatted version of the article will be published soon.

    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.

    Keywords: multiple myeloma, T-cell-redirecting therapy, bispecific antibodies, CAR T-cells, consensus statement, referral, adverse events BCMA, B cell maturation antigen, BsAb, bispecific antibody, CNS, central nervous system, ECOG, Eastern Cooperative Oncology Group, HIV, human immunodeficiency virus, NYHA, New York Heart Association, PFTs, pulmonary function tests

    Received: 10 Jun 2024; Accepted: 21 Oct 2024.

    Copyright: © 2024 Lancman, Song, White, Crosbie, Sharif, Emond, Saleem Raza, Elias, Kaedbey and Chu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Guido Lancman, Icahn School of Medicine at Mount Sinai, New York, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.