IMS 2025: Shifting Immunotherapies to Outpatient Care for Multiple Myeloma

In an interview with Pharmacy Times®, Yi Lin, MD, PhD, hematologist and oncologist at Mayo Clinic, discussed the advantages of shifting bispecifics and CAR T-cell therapies for multiple myeloma into the outpatient setting, noting improved access and the need to address hospital bed shortages. She highlighted her presentation, “Establishing outpatient administration of bispecifics and immunotherapy,” which she shared at the 22nd annual International Myeloma Society (IMS) meeting and exposition in Toronto, Canada.

Lin emphasized the importance of strong caregiver support, patient education, and well-prepared treatment centers to safely manage potential toxicities. She highlighted that pharmacists play a critical role in monitoring medications, preventing interactions, and ensuring timely access to treatments like tocilizumab and dexamethasone for managing adverse effects.

Pharmacy Times: What are the main advantages of shifting bispecifics and other immunotherapies into the outpatient setting for multiple myeloma patients?

Yi Lin, MD, PhD: Yeah, so we certainly have a growing number of both FDA-approved bispecifics and CAR Ts, as well as lots of trials. With these therapies, we're seeing really nice clinical responses, so there will be more patients who could potentially get the therapies and benefit from them.

Now, with both types of therapy, there are some immediate toxicities that require specialized care—specifically things like cytokine release syndrome and neurologic syndromes that can be associated with them. When we first started doing these in clinical trials, for safety reasons we kept patients inpatient so we could escalate care quickly. Many centers are finding out very quickly that there are just not enough hospital beds for the number of patients who could receive this treatment, so looking for ways to safely administer it outpatient is really needed to meet the growing demand.

The other thing is that we are evolving and learning how to manage these side effects, and newer generations of these therapies will be safer as well. This makes it possible to do them outpatient, so it is important to be proactive in thinking about logistics and setting up the infrastructure to support that.

Pharmacy Times: What infrastructure or care-team adjustments are most critical to safely deliver these therapies outside of the inpatient environment?

Lin: In terms of outpatient care, I think about it in a couple of different components. From a patient safety standpoint, they need to have good caregiver support. The caregiver needs to understand what to watch for, what is being asked of them, and the importance of transportation to come in for clinic visits or inpatient management in a timely fashion. The patient and caregiver need to understand what is expected of them in terms of monitoring and being compliant with that.

From the treatment center perspective, they need to have the capacity and proper staffing. For most patients, we can predict what will happen, and the risk of rapid progression of these side effects is quite low. Still, the center needs the capability to react quickly. That means having good procedures in terms of emergency department triage or having ways to rapidly admit them to inpatient services.

Pharmacy Times: What safety concerns, such as cytokine release syndrome or infection risk, should pharmacists be especially vigilant about in the outpatient setting?

Lin: We work a lot with our pharmacists as we treat more and more of these patients as outpatients. Certainly, in terms of medications for management, tocilizumab can be one of the drugs used quite early in managing cytokine release syndrome. Being able to prepare and release these drugs rapidly to address symptoms—similar to how you would as an inpatient—is very important.

Pharmacists play a critical role in reviewing with patients all their medications, checking for potential interactions, and addressing issues from patients and caregivers. At Mayo, and at some other institutions, very early or mild cytokine release syndrome can be treated with something like a small dose of dexamethasone that patients can take by mouth. Education about when to take it, when instructed by the team, and not taking it when it isn’t needed is very important.