Outpatient Administration of Bispecific Antibody Therapy for Hematologic Malignancies: A Practical Guide

Bispecific antibodies (BsAbs) are currently used to treat hematologic malignancies by cross-linking cytotoxic T cells with tumor cells and thus stimulating cellular immunity. Hyperactivation of T cells leads to dysregulated cytokine release, which causes the chief toxicities of BsAbs, cytokine release syndrome (CRS) and immune effector cell-mediated neurotoxicity syndrome (ICANS). On the basis of clinical trial experiences, standard practice is to hospitalize patients for intensive monitoring during periods when the risk of CRS and ICANS is highest. A strategy to safely administer these medications outpatient would improve patient access and reduce health care-associated costs. The lessons learned from outpatient administration of chimeric antigen receptor T cell therapy (CAR-T) may be applied to BsAbs given overlapping toxicity profiles. Outpatient delivery of BsAbs is feasible but requires a specialized multidisciplinary team, a robust infrastructure with well-defined standard procedures, and significant patient support and education. Emerging clinical practices, including prophylactic anti-inflammatory therapy and modified dosing schedules, further facilitate safe outpatient administration.