Overview
Elranatamab, a BCMA-directed bispecific antibody, requires step-up dosing (SUD) to mitigate cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). This retrospective study evaluated real-world outcomes and safety across care settings among 119 triple-class exposed patients with relapsed/refractory multiple myeloma in the Flatiron Health Research Database.
Most patients initiated step-up dosing in the inpatient setting (71%), while 16% received step-up dosing in the outpatient setting. Patients had a median of 5 prior lines of therapy (38% prior BCMA-exposed). Median real-world overall survival was 19.1 months and median progression-free survival was 12.4 months. CRS and ICANS incidence were 31% and 14% overall, respectively, and were predominantly Grade 1–2 with similar rates across inpatient and outpatient settings. No CRS, ICANS, or infection events resulted in treatment discontinuation or death.
Why this matters
These results support the real-world effectiveness and manageable safety profile of elranatamab in heavily pretreated multiple myeloma. The comparable toxicity rates between care settings indicate the feasibility of outpatient step-up dosing in routine practice.