New Data Highlight Pharmacists’ Expanding Roles in Hematologic Malignancies

Pharmacists are crucial members of the multidisciplinary team in the treatment of patients with hematologic malignancies such as multiple myeloma (MM) or with associated complications. They play a critical role by optimizing supportive care efforts, ensuring the safe use of complex immunotherapies, and guiding evidence-based therapeutic decisions across specialties. New pharmacist-led research presented at the 67th American Society of Hematology Annual Meeting and Exposition in Orlando, Florida, demonstrates their expanding roles in preventing infection with live-attenuated vaccines and standardizing management strategies for treatment-related toxicities.^1,2

Managing Cytokine Release Syndrome in Talquetamab-Treated Patients With Relapsed/Refractory MM

What Is Cytokine Release Syndrome?

Cytokine release syndrome (CRS) is an acute inflammatory response to the use of bispecific antibodies such as talquetamab (Talvey; Johnson & Johnson), which is approved by the FDA for the treatment of relapsed/refractory MM (RRMM). In the pivotal phase 1 MonumenTAL-1 (NCT03399799) clinical trial, CRS occurred in up to 80% of patients at mostly low grades, with some experiencing grade 3 or higher. For grades 1 and 2 CRS, guidelines recommend tocilizumab as an initial intervention prior to considering dexamethasone. A type of corticosteroid, dexamethasone can be used as an adjunct treatment, but data are limited on its efficacy and safety.^1,3,4

Pharmacists are important managers of dosing and administering medication to treat CRS—determining the optimal sequencing and safe selection of agents is critical for improving outcomes. In the current trial, led by Jessica McElwee, PharmD, BCOP, clinical pharmacist coordinator at Atrium Health, data from 7 academic medical centers were retrospectively examined to study the safety and efficacy of dexamethasone for CRS management in patients receiving talquetamab.¹

How Were the Data Analyzed?

Data from 211 patients with RRMM receiving commercial talquetamab were included; these patients received premedication and step-up dosing per the package insert. Responses were assessed utilizing criteria from the International Myeloma Working Group (IMWG). Key outcomes included incidence and severity of CRS events, CRS recurrence, treatment delay, and overall response rate (ORR).¹

A total of 129 (61%) of patients experienced CRS, with 43% experiencing grade 1 and 16% grade 2. Among these, dexamethasone was the first intervention in 46 patients (36%), tocilizumab in 42 (33%), and supportive care in 37 (29%); 4 patients received the 2 agents simultaneously.¹

Was Receiving Dexamethasone as Initial Treatment Effective at Resolving CRS?

For patients receiving dexamethasone first, 11 experienced concurrent immune effector cell–associated neurotoxicity syndrome, 33 (72%) had grade 1 CRS, and 11 (24%) had grade 2 CRS. For patients receiving tocilizumab first, 21 patients (50%) and 20 patients (48%) experienced grade 1 and 2 CRS, respectively. In the group of patients receiving dexamethasone first, CRS resolved following a single dose in 21 patients (46%), with repeat doses administered to 10 patients (22%), a subsequent tocilizumab dose to 12 patients (26%), and multiple tocilizumab doses to 2 patients (4%).¹

Of patients receiving tocilizumab first, CRS resolved following a single tocilizumab dose in 30 patients (71%), repeat tocilizumab doses in 5 patients (12%), a single dexamethasone dose in 2 patients (5%), and repeat dexamethasone doses in 5 patients (12%).¹

Did Bispecific Use Impact Myeloma Therapy?

“Like with chimeric antigen receptor [CAR] T-cell therapy, there is that theoretical risk that we could impact the response of our patients by using bispecifics,” McElwee addressed.

However, in a positive observation at 9.2 months, ORR for all patients was 77%, with 50% of patients achieving a very good partial response or better. Furthermore, the best ORR was similar (86% vs 90%; P = .74) between the dexamethasone and tocilizumab groups.¹

“It was encouraging to find that there were no differences in IMWG response rates,” McElwee added.¹

Although more patients who received dexamethasone first experienced recurrent CRS, the CRS was low grade and manageable. McElwee cautioned that, despite the safety and continued efficacy of myeloablative treatment, pharmacists should work with patients to determine which agent may be most suitable for their clinical picture, as some patients may not prefer dexamethasone over tocilizumab.¹

“I find that it’s a very love-hate relationship with dexamethasone,” McElwee explained. “I find that a majority of patients do not prefer to take large quantities of dexamethasone.”¹

The Role of Live-Attenuated Measles-Mumps-Rubella Vaccination in Patients Receiving Daratumumab

Why Are Vaccinations Important in Hematologic Care?

Infection prevention is a hallmark of care in patients undergoing antibody-based treatment with agents such as daratumumab (Darzalex; Johnson & Johnson), necessitating efforts to increase protection. Unfortunately, patients with MM who have undergone autologous stem cell transplantation (ASCT) or are receiving antibody-based treatment are contraindicated to live-attenuated vaccines—including the measles-mumps-rubella (MMR) vaccine—due to the risk of disseminated infections.²

As treatment with anti-CD38 antibodies, such as daratumumab, becomes increasingly integrated into clinical practice, it is imperative to better understand the risks associated with live-attenuated vaccination in immunocompromised patients. It is especially salient given the recent measles outbreak in the US, which has surpassed 1800 cases in 2025. With vaccine hesitancy growing in prevalence, fleshing out the safety of MMR vaccination is crucial for disseminating accurate information to patients who would benefit from vaccination.^2,5

“Despite what the current health administration is putting out there, hopefully most of us can agree that vaccines have prevented and continue to prevent millions of deaths around the world,” James Davis, PharmD, BCOP, malignant hematology pharmacy specialist at the Medical University of South Carolina, said during his presentation. Davis and a team of investigators conducted a multicenter retrospective study evaluating the safety of MMR vaccination in patients with multiple myeloma receiving daratumumab after ASCT.²

Was MMR Vaccination Safe in Daratumumab-Treated Patients With MM?

The authors analyzed data from 41 patients across 5 US academic medical centers. MMR vaccinations were administered at the discretion of the treating oncologist. A major limitation in the study addressed by Davis was the lack of vaccine titer measurements; this was not routine practice at the participating centers. Investigators looked for a series of safety outcomes, including adverse events (AEs) following vaccination, like infectious complications, confirmed infections, rash, and malaise.²

The initial MMR vaccination was administered at a median of 22 cycles (616 days) of daratumumab following ASCT, and 4 patients received a second dose of MMR; the median time from ASCT to MMR vaccination was 768 days. Common AEs were acute sinusitis (5%) and COVID-19 infection (5%), occurring a median of 8 days after MMR vaccination. Importantly, no active MMR infections developed post vaccination, and there were no hospitalizations or deaths.²

Despite the limited sample size, Davis said that the findings suggest safety with MMR vaccination in immunocompromised patients with MM receiving daratumumab after ASCT. Pharmacists can play a critical role as advocates for MMR vaccination and as vaccine administrators in the oncology setting, counseling patients and their caregivers on the benefits of vaccination. Given the risks, extensive monitoring should be employed in patients treated with daratumumab who receive a live-attenuated vaccine.²

REFERENCES

1. McElwee J, Elsey G, Gonzalez R, et al. Dexamethasone for management of cytokine release syndrome (CRS) associated with talquetamab in patients with relapsed/refractory multiple myeloma. Presented at: 67th American Society of Hematology (ASH) Annual Meeting and Exposition; December 7, 2025; Orlando, FL. Accessed via ASH virtual platform on December 8, 2025.

2. Davis J, McElwee J, Julian K, et al. Safety of live-attenuated MMR vaccination in patients with multiple myeloma receiving daratumumab after autologous stem cell transplantation. Presented at: 67th American Society of Hematology (ASH) Annual Meeting and Exposition; December 6, 2025; Orlando, FL. Accessed via ASH virtual platform on December 8, 2025.

3. Chari A, Minnema MC, Berdeja JG, et al. Talquetamab, a T-cell-redirecting GPRC5D bispecific antibody for multiple myeloma. N Engl J Med. 2022;387(24):2232-2244. doi:10.1056/NEJMoa2204591

4. Dose escalation study of talquetamab in participants with relapsed or refractory multiple myeloma (MonumenTAL-1). ClinicalTrials.gov. Updated December 5, 2025. Accessed December 8, 2025. https://clinicaltrials.gov/study/NCT03399799

5. Measles cases and outbreaks. CDC. Updated December 3, 2025. Accessed December 8, 2025. https://www.cdc.gov/measles/data-research/index.html