From Treatment Selection to Community Delivery: Pharmacists Advance Bispecific Care in Multiple Myeloma

Expanding BCMA-directed treatment options have changed the questions pharmacists face in relapsed/refractory multiple myeloma. Selecting the next regimen requires considering previous treatment exposure alongside the resources needed to deliver therapy safely. Across 5 Pharmacy Times Clinical Forum events in Atlanta, Georgia; Phoenix, Arizona; Chicago, Illinois; Cary, North Carolina; and Louisville, Kentucky, pharmacists examined how these decisions affect access and continuity of care.

Moderators included James Davis, PharmD, BCOP, a clinical pharmacy specialist at the Medical University of South Carolina; Sara Scott, PharmD, BCOP, a clinical pharmacy specialist in multiple myeloma at Emory Winship Cancer Institute; and Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, a pharmacy director at the University of Kansas Health System. Their discussions connected treatment sequencing with the practical requirements of bringing bispecific antibodies into community settings.

How Does Previous BCMA Exposure Shape Treatment Selection?

The expanding immunotherapy landscape requires clinicians to consider how one treatment could affect subsequent options. International Myeloma Working Group recommendations address this challenge by examining patient and disease factors alongside available sequencing evidence.¹

Participants frequently described favoring chimeric antigen receptor (CAR) T-cell therapy for eligible patients, particularly when a treatment-free interval was an important goal. However, rapidly progressing disease could make waiting for cellular therapy impractical. Caregiver availability and travel requirements also influenced decisions, making off-the-shelf bispecific antibodies important alternatives.

Retreatment after previous BCMA-directed therapy generated more nuanced discussion. Participants considered how long the previous response lasted and whether patients had received an intervening treatment. A prolonged remission after CAR T-cell therapy prompted different considerations than progression shortly after infusion. They also discussed changing targets with talquetamab rather than immediately returning to BCMA. These exchanges reflected individualized decisions rather than an established retreatment interval applicable to every patient.

Where Does Linvoseltamab Fit?

Linvoseltamab-gcpt (Lynozyfic; Regeneron Pharmaceuticals) received accelerated FDA approval in July 2025 for adults with relapsed/refractory multiple myeloma after at least 4 prior lines, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.²

The phase 1/2 LINKER-MM1 study (NCT03761108) provided the evidence supporting approval. In the updated analysis of 117 patients receiving 200 mg, median follow-up was 21.3 months. The objective response rate was 71%, with 52% achieving a complete response or better. Median duration of response reached 29.4 months; median progression-free survival was not reached, and median overall survival was 31.4 months.³

These findings describe a broader population than the 80 patients meeting the FDA-approved prior-treatment criteria, whose response rate was 70%. The trial excluded previous BCMA-directed CAR T-cell therapy or bispecific T-cell engager exposure, limiting extrapolation to BCMA retreatment.²

Administration logistics helped explain institutional interest. In Atlanta, Davis described why his institution added linvoseltamab: “We did get linvoseltamab because we like the weekly schedule for patients who maybe don’t live close to Charleston and don’t have to stay a long time in the hospital.”

Louisville participants likewise described selective formulary expansion, requiring an operational reason to add agents with different schedules.

Linvoseltamab begins with intravenous doses on days 1, 8, and 15. Dosing moves to every 2 weeks at week 14; patients meeting specified response and treatment-exposure criteria can transition to every 4 weeks at or after week 24.⁴ This provides an opportunity to reduce visit frequency during ongoing treatment. Participants nevertheless weighed infusion capacity and familiarity with existing subcutaneous therapies when considering adoption.

What Makes Community Administration Feasible?

Community delivery depended on institutional readiness. In Cary, Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP, FASHP, clinical oncology pharmacy manager at Atrium Health Levine Cancer Institute, emphasized that community sites differ substantially in staffing and proximity to hospital services.

“Are you ready? Have you operationalized this?” Moore asked.

Participants discussed after-hours triage and arrangements for urgent evaluation. Louisville discussion included home monitoring tools and bed availability, illustrating how planning extends beyond the infusion chair. Chicago participants also noted that infrequent use can make maintaining staff familiarity more difficult, reinforcing the value of accessible protocols and ongoing education.

In the updated LINKER-MM1 analysis, cytokine release syndrome (CRS) occurred in 46% of patients, predominantly during step-up dosing; grade 3 CRS occurred in 1%. Infections occurred in 75%, including grade 3 or higher infections in 48%.³ These findings require continued supportive care rather than implying that deep responses eliminate treatment risks.

Linvoseltamab carries boxed warnings for CRS and neurologic toxicity, including immune effector cell-associated neurotoxicity syndrome. Its label calls for 24-hour hospitalization after each of the first 2 step-up doses.⁴ Participants’ approaches to prophylactic tocilizumab varied by institution. Pharmacists must distinguish local strategies from labeled requirements; cross-trial percentages cannot establish one bispecific’s safety superiority.

How Can Pharmacists Strengthen Maintenance Care?

The transition from academic initiation to community maintenance created another opportunity for pharmacy involvement. In Phoenix, Danielle Keller, PharmD, MBA, director of pharmacy at Ironwood Cancer & Research Centers, emphasized direct contact between pharmacy teams.

“I think all I’d add is that I think the best handoff is a pharmacist-to-pharmacist handoff,” Keller said.

Participants described communicating dosing schedules and the reasoning behind treatment modifications so receiving teams could continue care confidently. Infection prevention also required explicit ownership. Linvoseltamab prescribing information directs clinicians to monitor infections and immunoglobulin levels and provide prophylaxis and immunoglobulin replacement according to guidelines.⁴

Participants also described off-label dosing-interval extensions, underscoring why handoffs must distinguish individualized decisions from approved schedules. The receiving team needs the rationale for any modification and clear instructions for supportive care.

Mahmoudjafari connected this work to the pharmacy’s influence on treatment delivery during the Chicago forum: “I think to your point, the transition to the outpatient has really been driven by pharmacy.” Her observation captured the shared implementation challenge: Expanding access requires pharmacists to build the processes that allow treatment to continue safely beyond the referring center.

References

1. Costa LJ, Banerjee R, Mian H, et al. International myeloma working group immunotherapy committee recommendation on sequencing immunotherapy for treatment of multiple myeloma. Leukemia. 2025;39(3):543-554. doi:10.1038/s41375-024-02482-6

2. FDA grants accelerated approval to linvoseltamab-gcpt for relapsed or refractory multiple myeloma. FDA. July 2, 2025. Accessed October 23, 2026. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-linvoseltamab-gcpt-relapsed-or-refractory-multiple-myeloma

3. Lee HC, Zonder JA, Dhodapkar MV, et al. Linvoseltamab in patients with relapsed/refractory multiple myeloma in the LINKER-MM1 study: longer follow-up and subgroup analyses. Clin Lymphoma Myeloma Leuk. 2026;26(2):e201-e212.e8. doi:10.1016/j.clml.2025.11.004

4. Lynozyfic (linvoseltamab-gcpt). Prescribing information. Regeneron Pharmaceuticals Inc; 2025. Accessed October 23, 2026. https://www.regeneron.com/downloads/lynozyfic_fpi.pdf