IMS 2025: Pharmacist Perspectives on Safety, Early Treatment, and Education in Multiple Myeloma

Paula Rodriguez-Otero, MD, PhD, associate professor and consultant in hematology at the University of Navarra in Pamplona, Spain, continued her conversation with Pharmacy Times® at the 22nd Annual International Myeloma Society (IMS) Meeting and Exposition in Toronto, Canada, discussing the importance of studying high-risk smoldering multiple myeloma. She noted that introducing therapy earlier in the disease course may delay or even prevent progression, with the potential to eradicate the disease at earlier stages. She also emphasized the vital role of pharmacists, patients, and caregivers in education, monitoring, and management of treatment-related toxicities.

Pharmacy Times: What were the key safety findings, and what adverse events should pharmacists be especially aware of in monitoring patients?

Paula Rodriguez-Otero, MD, PhD: With any bispecific antibody, and particularly with bispecific antibodies targeting BCMA, we need to be vigilant with three adverse events: cytokine release syndrome (CRS), neurological complications (what we call ICANS, which occurs in the vicinity of CRS), and infections.

If we look at these adverse events in the context of this study, 40% of the patients developed any grade of CRS, but all the events were grade 1, meaning patients only developed fever. Only one event was grade 2, which was fever plus hypotension that occurred after the first step-up. Overall, we see a lower incidence of grade 2 events compared to the relapsed/refractory setting.

We haven’t seen any ICANS so far in the study, which is very important. Regarding infections, the incidence of grade 3 infections remains very low. Only three patients out of 24 developed a grade 3 infection event. This also compares favorably to the safety profile in the relapsed setting.

Pharmacy Tmes: How might introducing therapy earlier in the disease course impact long-term outcomes and treatment strategies for multiple myeloma?

Rodriguez-Otero: The idea behind treating high-risk smoldering myeloma is to either delay disease progression or, in the best-case scenario, completely prevent disease progression. This would mean patients would never develop any SLiM-CRAB criteria and would never move into active disease.

The hypothesis is that by using these platforms that provide such depth of response, we will get closer to achieving the goal of completely eradicating the disease in the earlier stages.

Pharmacy Times: What role do you see pharmacists playing in patient education, monitoring, and adherence if linvoseltamab becomes a treatment option for HR-SMM?

Rodriguez-Otero: This is a very important question, and I think it is the responsibility of everyone involved in the care of the patient to educate about management—what adverse events we need to expect, how to identify them, how to prevent them, and how to better manage them.

These are new treatments with new toxicities, so all of us need to be educated, including patients and caregivers. Caregivers are critical in this process, as they are often the ones who notice symptoms and report them to the doctor. It is important to educate caregivers, patients, pharmacists, and doctors so that everyone understands how these drugs work and how to better manage them.