Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA

Zahra Mahmoudjafari, PharmD, BCOP, FHOPA, MBA, challenges the assumption that oral agents (belumosudil) are inherently more convenient than intravenous therapy (axatilimab) by highlighting that the intravenous schedule creates structured monitoring touchpoints and that mechanism differences—not route alone—should drive sequencing decisions in heavily pretreated populations.

Brooke Adams, PharmD, BCOP, walks through the operational mechanics of transitioning cGVHD patients to community settings: coordination touchpoints, common failure points, and 90-day post-transition checkpoints that confirm a successful handoff.

Zahra Mahmoudjafari, PharmD, BCOP, FHOPA, MBA, addresses the tension between objective NIH scoring and subjective patient experience, and how pharmacists can document patient-reported outcomes to support clinical recommendations, particularly when partial responses demonstrate meaningful functional improvement.

Brooke Adams, PharmD, BCOP, explores how patient narratives on axatilimab inform treatment decisions, moving beyond National Institutes of Health response criteria to functional outcomes—return to work or family activities, reduction in pain or skin discomfort, improved sleep—and how these improvements may exceed what clinical response rates alone predict.

Zahra Mahmoudjafari, PharmD, BCOP, FHOPA, MBA, describes the pharmacist-to-pharmacist handoff workflow when patients with cGVHD transition from the transplant center to outpatient or home infusion settings, including essential documentation elements, baseline assessments, and red-flag symptoms that require immediate clinical contact.

Brooke Adams, PharmD, BCOP, identifies the clinically meaningful adverse effects every pharmacist must monitor—periorbital edema, hepatic enzyme elevations, fatigue—and specifies intervention thresholds (grading, dose modifications, hold criteria) that should trigger escalation conversations with prescribers.

Zahra Mahmoudjafari, PharmD, BCOP, FHOPA, MBA, discusses how axatilimab performs in actual practice versus what AGAVE-201 predicted, including responses in organ manifestations not well-represented in the trial and how real-world monitoring protocols have evolved based on accumulated clinical experience.

Brooke Adams, PharmD, BCOP, walks through the axatilimab trial data (AGAVE-201) and belumosudil trial populations, highlighting how differences in study design, patient characteristics, and end points affect pharmacist interpretation and comparability, and what gaps exist in the evidence base for specific organ manifestations.

Zahra Mahmoudjafari, PharmD, BCOP, FHOPA, MBA, translates the CSF1R-targeted mechanism into practical pharmacist workflows: distinct toxicity profiles (periorbital edema, hepatic enzyme elevations), drug interaction review for polypharmacy, and how to communicate the mechanistic rationale to patients and community pharmacy teams.

Brook Adams, PharmD, BCOP, explains axatilimab's distinct mechanism targeting the CSF1R pathway on macrophages and monocytes—as opposed to T-cell pathways (ibrutinib) or JAK/STAT signaling (ruxolitinib)—and why this mechanistic differentiation is clinically meaningful when patients have already progressed on other agents.

Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, discusses how axatilimab fits into formulary placement and treatment sequencing decisions at her institution, including how the multidisciplinary transplant team aligns on when to initiate therapy and whether clinical scenarios exist in which the conversation might occur earlier than strictly in the third line.

Brooke Adams, PharmD, BCOP, describes the clinical reality of third-line cGVHD: patients with relapsed or refractory disease after steroids, calcineurin inhibitors, and at least 1 approved second-line agent.

In the final episode, 'From Knowledge to Action: Final Takeaways for Oncology Pharmacists Implementing Bispecific Therapy,' the panelists explored the following critical question:

In Outpatient Bispecific Initiation: Emerging Trends, Eligibility Criteria, and Operational Readiness, our panel of experts address a critical question.

In this episode, 'Sequencing in Focus: Pharmacists Reflect on the Impacts of MajesTEC-3 and MajesTEC-9 Data in Myeloma,' the oncology pharmacists explore the following questions:

Zahra Mahmoudjafari expressed optimism about the remarkable evolution of multiple myeloma management over her career while acknowledging the significant responsibility that accompanies the expanding therapeutic landscape, emphasizing the need for operational infrastructure that ensures appropriate access, continued advocacy around Risk Evaluation and Mitigation Strategy (REMS) programs, and strong cross-specialty partnerships such as those with ophthalmology that are critical to safely delivering agents like belantamab mafodotin.

Zahra Mahmoudjafari outlined best practices for pharmacist-led patient education across all three BCMA-directed therapy classes, emphasizing the importance of tailored, proactive counseling that accounts for the unique toxicity profiles of each agent, including cytokine release syndrome (CRS) and neurotoxicity risk with CAR T-Cell therapies and bispecific antibodies, ocular symptoms such as blurred vision and dry eye with belantamab mafodotin, and infection risk across all modalities, while also stressing the critical role of care partners in recognizing and escalating adverse events early.

This episode, titled 'Availability, Patient Preference, and Linvoseltamab: What Pharmacists Need to Know About the Evolving Bispecific Landscape,' features oncology pharmacists discussing the following critical questions:

In 'Patient Selection and Line-of-Therapy Navigation: Practical Insights for a Complex Myeloma Treatment Landscape,' our panel of experts delve into the following critical questions:

Oncology pharmacists unite care teams like World Cup midfielders—coordinating safe care and supporting patients through hope, setbacks, and dignity.

Al-Ola Abdallah outlined the key adverse events associated with bispecific antibodies, noting that while CRS occurs in over 70% of patients, the majority of cases are grade 1 or 2 and therefore manageable in outpatient settings with appropriate infrastructure, while ICANS is less commonly observed at severe grades compared with CAR T-Cell therapy.

Zahra Mahmoudjafari explained that REMS programs are a Food and Drug Administration (FDA) mechanism designed to ensure that the safety risks associated with specific therapies are clearly communicated to prescribers, healthcare facilities, pharmacies, and patients, noting that each REMS program is unique and that BCMA-directed therapies currently carry REMS requirements for bispecific antibodies due to cytokine release syndrome (CRS) and neurotoxicity risks, and for belantamab mafodotin due to ocular toxicity, while the REMS programs previously required for CAR T-Cell therapies were recently removed.

In this episode, 'The Long-Term Infection Risk: How Pharmacists Are Approaching Prophylaxis and Monitoring in Bispecific Myeloma Care,' the oncology pharmacists explore the following questions:

In this episode, 'From Treatment to Prevention: How Pharmacists Are Refining CRS Management for Bispecific Antibody Therapy,' the oncology pharmacists explore the following questions:

Zahra Mahmoudjafari noted that while patients with high disease burden, a history of severe cytokine release syndrome (CRS) or neurotoxicity, poor performance status, or limited caregiver support were historically considered less suitable for community-based administration, significant progress has been made as community centers develop strong patient selection criteria, outpatient roadmaps, and escalation strategies, often in partnership with academic centers for initial step-up dosing.

Zahra Mahmoudjafari emphasized that treatment sequencing in relapsed/refractory multiple myeloma (RRMM) must be highly individualized, taking into account prior BCMA exposure, disease burden, caregiver support, logistical factors, comorbidities, and institutional access to specific therapies such as CAR T-cell therapy, noting that while a standardized algorithm would be ideal, the complexity of the disease and evolving evidence base make a one-size-fits-all approach impractical.

In 'Getting CRS Right: Clinical Presentation, Appropriate Response, and Building a Well-Educated Care Team,' our panel of experts delve into the following critical questions:

In this episode, 'Reducing Hospitalization Without Compromising Safety: Step-Up Dosing Criteria and Best Practices in Myeloma,' the oncology pharmacists explore the following questions:

Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, highlights key bispecific antibody updates from ASCO and EHA, including updated data from the MajesTEC-6 trial evaluating elranatamab plus daratumumab and lenalidomide in newly diagnosed patients, and the MajesTEC-5 data demonstrating high response rates and minimal residual disease negativity with teclistamab-based induction in transplant-eligible patients, as well as a growing trend toward less frequent dosing schedules to reduce treatment burden and infection risk, and increasing real-world evidence supporting outpatient step-up dosing administration at both academic and community sites.

Anjulie Quick explained that belantamab mafodotin affects corneal epithelial cells in addition to myeloma cells, leading to keratopathy and symptoms including decreased vision, dry eye, and photophobia, and outlined the ophthalmologist's critical role within the Risk Evaluation and Mitigation Strategy (REMS) program, which requires baseline eye exams prior to treatment initiation and ongoing examinations before every dose.