Test
dg-publish
| Multiple Myeloma | ||||
| Bispecific Antibody (Brand Name) | ||||
| Elranatamab (ELREXFIO) | Talquetamab (TALVEY) |
Teclistamab (TECVAYLI) | ||
| Statistics | ||||
| Median onset of CRS (after last dose) | 48 hours | 48 hours | 48 hours | |
| Median duration of CRS | 48 hours | 48 hours | 48 hours | |
| Occurrence of CRS during step-up doses | 90.6% | 81.7% | 78.8% | |
| CRS Grading and Criteria | Instructions for management | |||
| Grade 1 Temperature ≥ 38° C |
· Supportive therapy and withhold elranatamab until CRS resolution | · Withhold treatment until CRS resolution · Administer pre-medication prior to next dose |
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| Grade 2 Temperature ≥ 38° C with either: · Hypotension not requiring vasopressors and responsive to fluids AND/OR · Oxygen requirement ≤ 6 L/min (low-flow nasal cannula or blow-by) |
· Supportive therapy and withhold elranatamab until CRS resolution · Monitor patient once daily for 48 hours following next dose · Patients must remain near healthcare facility |
· Withhold treatment until CRS resolution · Administer pre-medication prior to next dose · Monitor patient once daily for 48 hours following next dose · Patients must remain near healthcare facility Tocilizumab · Administer IV tocilizumab 8 mg/kg over 1 hour (do not exceed 800 mg) · Repeat tocilizumab 8-hourly if requiring increased supplemental oxygen or not responsive to IV fluids · Limit of 3 doses within 24 hours, maximum of 4 doses overall Corticosteroids · If no improvement of CRS after starting tocilizumab within 24 hours, start either: o IV methylprednisolone 1mg/kg 12-hourly OR o IV dexamethasone 10mg 6-hourly · Continue corticosteroids until CRS ≤ Grade 1, then gradually taper over 72 hours |
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| Grade 3 (duration < 48h) Temperature ≥ 38° C with either: · Hypotension requiring one vasopressor with or without vasopressin AND/OR · Oxygen requirement > 6 L/min (high-flow nasal cannula, facemask, Venturi mask or non-rebreather mask) |
· Supportive therapy, which may include intensive care, and withhold elranatamab until CRS resolution · Administer pre-medication prior to next dose · Monitor patient once a day for 48 hours following next dose · Patients must remain near healthcare facility |
· Withhold treatment until CRS resolution · Administer pre-medication prior to next dose · Monitor patient once daily for 48 hours following next dose · Patients must remain near healthcare facility Tocilizumab · Administer IV tocilizumab 8 mg/kg over 1 hour (do not exceed 800 mg) · Repeat tocilizumab 8-hourly if requiring increased supplemental oxygen or not responsive to IV fluids · Limit of 3 doses within 24 hours, maximum of 4 doses overall Corticosteroids · If no improvement of CRS after starting tocilizumab, start either: o IV methylprednisolone 1mg/kg 12-hourly OR o IV dexamethasone 10mg 6-hourly · Continue corticosteroids until CRS ≤ Grade 1, then gradually taper over 72 hours |
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| Grade 3 (duration ≥ 48h or recurrent) Temperature ≥ 38° C with either: · Hypotension requiring one vasopressor with or without vasopressin AND/OR · Oxygen requirement > 6 L/min (high-flow nasal cannula, facemask, Venturi mask, non-rebreather mask) |
· Permanently discontinue elranatamab · Supportive therapy, which may include intensive care |
· Permanently discontinue therapy Tocilizumab · Administer IV tocilizumab 8 mg/kg over 1 hour (do not exceed 800 mg) · Repeat tocilizumab 8-hourly if requiring increased supplemental oxygen or not responsive to IV fluids · Limit of 3 doses within 24 hours, maximum of 4 doses overall Corticosteroids · If no improvement of CRS after starting tocilizumab, start either: o IV methylprednisolone 1mg/kg 12-hourly OR o IV dexamethasone 10mg 6-hourly · Continue corticosteroids until CRS ≤ Grade 1, then gradually taper over 72 hours |
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| Grade 4 Temperature ≥ 38° C with either: · Hypotension requiring more than one vasopressor (excluding vasopressin) AND/OR · Oxygen requirement of positive pressure (CPAP, BiPAP, mechanical ventilation and intubation) |
· Permanently discontinue elranatamab · Supportive therapy, which may include intensive care |
· Permanently discontinue therapy Tocilizumab · Administer IV tocilizumab 8 mg/kg over 1 hour (do not exceed 800 mg) · Repeat tocilizumab 8-hourly if requiring increased supplemental oxygen or not responsive to IV fluids · Limit of 3 doses within 24 hours, maximum of 4 doses overall Corticosteroids · If no improvement of CRS after starting tocilizumab, start either: o IV methylprednisolone 1mg/kg 12-hourly OR o IV dexamethasone 10mg 6-hourly OR o IV methylprednisolone 1000mg 24-hourly for 72 hours under clinical discretion · If CRS deteriorates or no improvement, switch to alternative immunosuppressants |
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| Lymphoma | ||||
| Statistics | Glofitamab (COLUMVI) | Epcoritamab (TEPKINLY) | ||
| Median onset of CRS (after last dose) | 12.6 hours after 2.5mg dose 28.2 hours after 10mg dose 28.2 hours after 30mg dose |
20 hours | ||
| Median duration of CRS | 31.8 hours after 2.5mg dose 16.5 hours after 10mg dose 18.9 hours after 30mg dose |
48 hours | ||
| Majority of CRS occurrence | 54.5% after 2.5mg dose (cycle 1, day 8) 33.3% after 10mg dose (cycle 1, day 15) 26.8% after 30mg dose (cycle 2) |
42.7% after first full dose of 48mg (cycle 1, day 15) | ||
| CRS Grading and Criteria | Instructions for management | |||
| Grade 1 Temperature ≥ 38° C with no hypotension or supplementary oxygen requirement |
CRS during infusion · Temporarily stop infusion, manage symptoms and restart at slower rate once symptoms resolved for ≥ 72 hours · If symptoms reappear, discontinue current infusion CRS following infusion · Manage symptoms · Restart infusion at slower rate once symptoms resolved for ≥ 72 hours CRS duration of ≥ 48 hours after symptom management · Consider tocilizumab and corticosteroids |
· Supportive therapy (including antipyretics and IV fluids) and withhold epcoritamab until CRS resolution Tocilizumab · Consider IV tocilizumab 8mg/kg over 1 hour (do not exceed 800mg) in: o Advanced age o High tumour burden o Circulating tumour cells o Fever refractory to antipyretics · Repeat tocilizumab after 8 hours as needed, with a limit of 2 doses within 24 hours · Alternative anti-cytokine therapy required if concurrent ICANS Corticosteroids o Dexamethasone 10-20mg daily o Corticosteroids highly recommended in concurrent ICANS |
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| Grade 2 Temperature ≥ 38° C with: · Hypotension not requiring vasopressors AND/OR · Oxygen requirement ≤ 6 L/min (low-flow nasal cannula or blow-by) |
CRS during infusion · Discontinue current infusion and manage symptoms, restart at slower rate once symptoms resolved for ≥ 72 hours · Consider IV tocilizumab 8mg/kg 8-hourly · Administer corticosteroids o IV dexamethasone 10-20mg 24-hourly OR o IV prednisolone 100mg 24-hourly OR o IV methylprednisolone 1-2mg/kg 24-hourly CRS following infusion · Manage symptoms, restart at slower rate once symptoms resolved for ≥ 72 hours and monitor patients following infusion · Consider IV tocilizumab 8mg/kg 8-hourly · Administer corticosteroids o IV dexamethasone 10-20mg 24-hourly OR o IV prednisolone 100mg 24-hourly OR o IV methylprednisolone 1-2mg/kg 24-hourly Note on limit of doses of tocilizumab · Limit of 3 doses in 6 weeks If 0 or 1 doses of tocilizumab within 6 weeks previously given: · Administer first dose · Administer second dose after 8 hours if no improvement · Consider alternative anti-cytokine therapy after 2 doses with no improvement If 2 doses of tocilizumab within 6 weeks previously given: · Administer first dose · Consider alternative anti-cytokine therapy after 1 dose with no improvement |
· Supportive therapy (including antipyretics and IV fluids) and withhold epcoritamab until CRS resolution Tocilizumab · Administer IV tocilizumab 8mg/kg over 1 hour (do not exceed 800mg) · Repeat tocilizumab after 8 hours as needed, with a limit of 2 doses within 24 hours · If CRS refractory to anti-cytokine therapy, increase corticosteroid dose and seek alternative anti-cytokine therapy · Alternative anti-cytokine therapy required if concurrent ICANS Corticosteroids o Dexamethasone 10-20mg daily o Corticosteroids highly recommended in concurrent ICANS |
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| Grade 3 Temperature ≥ 38° C with: · Hypotension requiring one vasopressor with or without vasopressin AND/OR · Oxygen requirement > 6 L/min (high-flow nasal cannula, facemask, Venturi mask or non-rebreather mask) |
· If ≥ Grade 3 CRS at subsequent infusion, permanently discontinue glofitamab CRS during infusion · Discontinue current infusion and manage symptoms, restart at slower rate once symptoms resolved for ≥ 72 hours and monitor patients following infusion · Administer IV tocilizumab 8mg/kg 8-hourly · Administer corticosteroids o IV dexamethasone 10-20mg 24-hourly OR o IV prednisolone 100mg 24-hourly OR o IV methylprednisolone 1-2mg/kg 24-hourly CRS following infusion · Manage symptoms, restart at slower rate once symptoms resolved for ≥ 72 hours and monitor patients following infusion · Administer IV tocilizumab 8mg/kg 8-hourly · Administer corticosteroids o IV dexamethasone 10-20mg 24-hourly OR o IV prednisolone 100mg 24-hourly OR o IV methylprednisolone 1-2mg/kg 24-hourly Note on limit of doses of tocilizumab · Limit of 3 doses in 6 weeks If 0 or 1 doses of tocilizumab within 6 weeks previously given: · Administer first dose · Administer second dose after 8 hours if no improvement or rapid degeneration of CRS · Consider alternative anti-cytokine AND/OR alternative immunosuppressive therapy after 2 doses If 2 doses of tocilizumab within 6 weeks previously given: · Administer first dose · Consider alternative anti-cytokine AND/OR alternative immunosuppressive therapy after 1 dose if no improvement within 8 hours or rapid degeneration of CRS |
· Supportive therapy (including antipyretics and IV fluids) and withhold epcoritamab until CRS resolution · Permanently discontinue epcoritamab in the following cases: o Grade 3 CRS lasting ≥ 72 hours o 2+ separate CRS events, even if resolved to ≤ Grade 2 within 72 hours Tocilizumab · Administer IV tocilizumab 8mg/kg over 1 hour (do not exceed 800mg) · Repeat tocilizumab after 8 hours as needed, with a limit of 2 doses within 24 hours · If CRS refractory to anti-cytokine therapy, increase corticosteroid dose and seek alternative anti-cytokine therapy · Alternative anti-cytokine therapy required if concurrent ICANS Corticosteroids o IV dexamethasone 10-20mg 6-hourly o If no response to dexamethasone, administer IV methylprednisolone 1000mg 24-hourly o Corticosteroids highly recommended in concurrent ICANS |
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| Grade 4 Temperature ≥ 38° C with: · Hypotension requiring two or more vasopressors (excluding vasopressin) AND/OR · Oxygen requirement of positive pressure (CPAP, BiPAP, mechanical ventilation and intubation) |
CRS during or following infusion · Permanently discontinue glofitamab and manage symptoms · Administer IV tocilizumab 8mg/kg 8-hourly · Administer corticosteroids o IV dexamethasone 10-20mg 24-hourly OR o IV prednisolone 100mg 24-hourly OR o IV methylprednisolone 1-2mg/kg 24-hourly Note on limit of doses of tocilizumab · Limit of 3 doses in 6 weeks If 0 or 1 doses of tocilizumab within 6 weeks previously given: · Administer first dose · Administer second dose after 8 hours if no improvement or rapid degeneration of CRS · Consider alternative anti-cytokine AND/OR alternative immunosuppressive therapy after 2 doses If 2 doses of tocilizumab within 6 weeks previously given: · Administer first dose · Consider alternative anti-cytokine AND/OR alternative immunosuppressive therapy after 1 dose if no improvement within 8 hours or rapid degeneration of CRS |
· Supportive therapy (including antipyretics and IV fluids) and permanently discontinue epcoritamab Tocilizumab · Administer IV tocilizumab 8mg/kg over 1 hour (do not exceed 800mg) · Repeat tocilizumab after 8 hours as needed, with a limit of 2 doses within 24 hours · If CRS refractory to anti-cytokine therapy, increase corticosteroid dose and seek alternative anti-cytokine therapy · Alternative anti-cytokine therapy required if concurrent ICANS Corticosteroids o IV dexamethasone 10-20mg 6-hourly o If no response to dexamethasone, administer IV methylprednisolone 1000mg 24-hourly o Corticosteroids highly recommended in concurrent ICANS |