IMS 2025: Improving Outcomes with Bispecifics in Multiple Myeloma

In an interview with Pharmacy Times®, Marc Raab, MD, professor of medicine and clinical director at the Heidelberg University Medical Center, discussed the promising results of teclistamab in frontline multiple myeloma treatment, with nearly all patients achieving MRD negativity after induction therapy. These findings were shared at the 22nd annual International Myeloma Society (IMS) meeting and exposition in Toronto, Canada, suggesting the potential to shorten treatment duration and improve outcomes compared with standard regimens. However, he noted that longer follow-up and randomized trials are needed. Raab emphasized infection risk as the main safety concern, highlighting the importance of prophylaxis, IVIG supplementation, and patient education to optimize care.

Pharmacy Times: Can you start by introducing yourself?

Marc Raab, MD: I'm Marc Raab from Heidelberg, Germany, heading the Heidelberg Myeloma Center at the University Hospital there.

Pharmacy Times: What did the updated minimal residual disease (MRD) findings reveal, and how might these outcomes influence frontline treatment strategies?

Raab: Yeah, I mean, the new bispecifics, like PCMA bispecific specifically, have already, in late lines, shown very promising and unprecedented results for a monotherapy where they gained approval as well. And of course, now there's a lot of rationale to explore that in earlier lines.

The trial that we are running, the DSM GMMG trial, together with J&J, is exploring this in frontline transplant-eligible patients. And of course, in the frontline, we have the standard of care with Dara-VRD or Isa-RVD, the quadruplet combination therapies. So it makes a lot of sense to explore a drug that is as potent as teclistamab in the frontline, in combination with standard-of-care drugs.

Pharmacy Times: What did the updated minimal residual disease (MRD) findings reveal, and how might these outcomes influence frontline treatment strategies?

Raab: What we found is that all patients we were able to test in this cohort—and that was actually every patient except for one where we didn't have any samples—achieved MRD negativity. Out of 49 patients, 48 achieved MRD negativity, even down to 10^-6.

With induction therapy, almost all patients were MRD negative already after three cycles, and the remaining patients after six cycles. This compares to other combination therapies by almost doubling the numbers in this set. Of course, you can't get higher than 100%.

So that might have implications in how we view frontline therapy, at least in the transplant setting in the future. If you don’t need long therapy to eradicate the disease, as far as you can tell based on MRD testing, then you might limit treatment duration if you think ahead. Of course, this needs to be proven with longer follow-up, more patients, and in a randomized fashion, but that is the principle of how this finding can impact long-term treatment strategies.

Pharmacy Times: What safety or tolerability considerations should pharmacists be most aware of when managing patients on teclistamab in the induction setting?

Raab: Overall, the tolerability was quite good. Side effects seen at the beginning included CRS, which were all grade 1 and 2 and very manageable. Some rash at the beginning resolved nicely with steroids if needed.

The biggest concern you have to keep in mind is always infection. That’s the case with all PCMA bispecifics, and here we had about a third of patients experience higher-grade infections during induction, which is a bit higher than with standard of care. That’s why you need to implement strict surveillance but also prophylactic measures like IVIG supplementation, antiviral prophylaxis, and antibacterial PCP prophylaxis to keep the rate as low as possible.

Luckily, we didn’t have any grade 5 events—no patient died because of infections, and no patient stopped treatment because of infections.

Pharmacy Times: From a pharmacist’s perspective, what are the key monitoring and supportive care priorities to optimize outcomes for patients receiving teclistamab-based induction therapy?

Raab: Supplementing IVIG, so immunoglobulin supplementation, as soon as levels drop below 400 mg/dL, is the key priority. We would also strongly recommend antibiotic prophylaxis—PCP prophylaxis like Bactrim or some fluoroquinolones—at least for the first three to six cycles. Antiviral prophylaxis, such as acyclovir or similar drugs, is also important.

And of course, educating the patient is crucial. While it’s not the pharmacist’s sole responsibility, pharmacists play a role in ensuring patients know to look after themselves and report immediately to their center once they have signs of infection.