IMS 2025: Pharmacist Role in Optimizing Outcomes with Elranatamab

In an interview with Pharmacy Times®, Matthew Lei, PharmD, BCOP, clinical pharmacy specialist from Massachusetts General Hospital, further discussed key considerations for pharmacists in counseling and monitoring patients receiving elranatamab, which he shared at the 22nd annual International Myeloma Society (IMS) meeting and exposition in Toronto, Canada.

Lei highlighted the importance of infection prophylaxis, CRS and ICANS mitigation, and the pharmacist’s role in supportive care and outpatient management. Lei also emphasized that consolidated therapy with T-cell engagers post-CAR T is feasible, with potential for deeper responses and sustained remission in relapsed or refractory multiple myeloma.

Pharmacy Times: What should pharmacists be aware of when counseling or monitoring patients on elranatamab?

Matthew Lei, PharmD, BCOP: So we know that post-CAR T, for patients with low myeloma, infection is a notable concern. Especially with using a BCMA T-cell engager post-BCMA CAR T, infection is a very notable concern. With the updated NCCN guidelines in multiple myeloma recommending primary prophylaxis with IVIG, pharmacists have an important role in making sure that the supportive care strategy is implemented, as well as appropriate monitoring, prophylaxis, and treatment for infections, including prophylaxis for VZV and PJP. For high-risk patients, especially during neutropenia, it is important to consider antibacterial infection prophylaxis when appropriate.

CRS mitigation and ICANS monitoring are also important considerations. Some centers have utilized tocilizumab prophylaxis, and others have demonstrated the feasibility of post-treatment dexamethasone prophylaxis. Notably, in patients who are post-IDE-CEL, about a third experienced CRS, all of which were grade 1. Half the patients were stepped up and monitored as outpatients. In that context, pharmacists can play a role in facilitating collaboration with the medical team and in selecting patients who may receive, with appropriate monitoring, some dosing as outpatients.

Pharmacy Times: From a pharmacist’s perspective, what are the most important takeaways from this study in terms of patient management, toxicity mitigation, and optimizing outcomes in RRMM?

Lei: The major takeaway from the study is that consolidated therapy with T-cell engagers or immune-based therapies post-CAR T is feasible. We do see a deepening of response with the goal of increasing rates of sustained MRD. From CARTITUDE-1, we appreciate that sustained disease remission is possible.

We will likely see more combination sequential strategies for patients with myeloma, especially in the frontline and in patients with less refractory disease. It is important to consider toxicities and supportive care for patients receiving sequential immune-based therapies, being mindful that patients may still have lingering cytopenias post-CAR T. We must also account for toxicities depending on the specific antigen of interest, such as GPRC5D versus BCMA.