The Evolving Role of Bispecific Antibodies in Multiple Myeloma

In an interview with Pharmacy Times at the 2026 Community Oncology Alliance (COA) Conference, Brooke Adams, PharmD, BCOP, Clinical Pharmacy Specialist, Blood and Marrow Transplantation and Cellular Therapy at Orlando Health, discusses the evolving role of bispecific antibodies in multiple myeloma. She emphasizes their lower risk of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) compared with CAR T-cell therapy, enabling safer outpatient treatment. Adams also highlights the importance of pharmacist-led supportive care and education, as well as emerging data suggesting these therapies may allow for treatment-free intervals in the future.

Pharmacy Times: Given your background in stem cell transplant and cellular therapy, how do the safety and monitoring considerations for bispecific antibodies compare, and what should community pharmacists be most prepared for?

Brooke Adams, PharmD, BCOP: So that's a great question. When it comes to bispecific antibodies, we know they're highly efficacious and that all of our patients deserve these therapies, but we have done a bad job extrapolating the risk of CRS and ICANS to be the same as CAR T—they're not. They have much lower rates of CRS and ICANS. When we compare them, we know we can get away with steroids very early on when we just get grade one CRS or grade one ICANS, and we can prevent that escalation to higher grades, to the point that we're doing this outpatient in the communities.

Pharmacy Times: In patients receiving BsAb therapies, how can pharmacists proactively manage risks like infection or immune-related complications, particularly in more complex or immunocompromised populations?

Adams: Absolutely. So in my practice, I'm the one that built all of our treatment plans. When I built our treatment plans, I ensured all of those lovely a la carte items fell into them. So all of the prophylactic antimicrobials—I’m the one that ensures those prescriptions get sent to the pharmacy and patients understand why they should take them—and IVIG. We try to get IVIG authorization up front whenever we're applying these treatment plans for our patients, because we know how important IVIG is when it comes to keeping their immunoglobulins up so that they can fight infections. Because you cannot expect a patient's T cells to be bound to these bispecific antibodies and fight off infections—that's just not fair. So they need all of these a la carte support items, and me, as a pharmacist in my practice, have really owned that for our patients.

Pharmacy Times: With minimal residual disease (MRD) becoming increasingly important in multiple myeloma, how do you see MRD assessment influencing treatment decisions and potentially guiding the use of bispecific antibodies in the future?

Adams: Yeah, so ASH had an explosion of clinical trials when it comes to bispecific antibodies in the multiple myeloma space, and our dream for our multiple myeloma patients is to get in that sexy CR with MRD negativity, and bispecific antibodies are getting us there. So they may define treatment durations in the future. Instead of these being until disease progression or unacceptable toxicity, maybe you're MRD negative for x number of months, and you get a drug holiday—you get freedom—which is amazing for our patients. There was also a study that was done after transplant—autologous transplant for multiple myeloma—that showed that those that were MRD positive after the end of transplant were given 4 cycles of a bispecific antibody, and 100% of those patients got MRD negative after those four cycles. So just buckle up—this is coming, and it's truly an exciting time for our patients.

Pharmacy Times: From a training and education standpoint, what competencies should oncology pharmacy teams prioritize to effectively support the growing use of bispecific antibodies in community practice?

Adams: That's a wonderful question. Education is key, and it's not just education of pharmacists, physicians, nurses, and APPs—it’s education of anybody that can touch these patients: your emergency room colleagues, your primary care colleagues, and your ICU colleagues. They all need to be educated. I’m one of the primary educators at my site. I developed all of the education materials, and I truly enjoy it. So going around every time we have a new nurse, a new physician, a new APP, a new pharmacist, or emergency room staff—it takes constant education. So this education is not going away, and it's extremely important they understand the risks of CRS, ICANS, myelosuppression, and infections along the way.