Consensus recommendations on the management of toxicity associated with CD3×CD20 bispecific antibody therapy

Area of Science:

• Oncology
• Immunotherapy
• Hematology

Background:

• Bispecific antibodies (BsAbs) targeting CD3 and CD20 are a significant advancement in treating B-cell non-Hodgkin lymphoma.
• These therapies show notable efficacy in pretreated patients, with several already approved globally.
• However, BsAbs can cause severe toxicities, primarily cytokine release syndrome (CRS), due to T-cell activation.

Purpose of the Study:

• To develop consensus-based recommendations for managing toxicities associated with CD3×CD20 bispecific antibody therapy.
• To address the need for specific guidance beyond existing algorithms for CAR T-cell therapies.
• To provide practical strategies for anticipating, mitigating, and managing adverse events.

Main Methods:

• Convened an international panel of experts including physicians, advanced practitioners, nurses, and pharmacists.
• Included professionals with experience in both clinical trials and real-world settings using CD3×CD20 BsAbs.
• Developed consensus-based recommendations through collaborative discussion and review.

Main Results:

• Identified key differences in the timing, quality, and severity of toxicities between BsAbs and CAR T-cell therapies.
• Established specific guidance for the assessment and management of CD3×CD20 BsAb-related toxicities.
• Provided a framework for healthcare professionals to manage CRS and neurotoxicity.

Conclusions:

• CD3×CD20 BsAbs represent a milestone in lymphoma treatment, but require careful toxicity management.
• Existing toxicity management algorithms for CAR T-cells need adaptation for BsAb-specific profiles.
• This expert consensus provides crucial guidance for the safe and effective implementation of BsAb therapy in clinical practice.