Experiences with real-world teclistamab administration in community and outpatient settings: a mixed-methods study of hematology providers

Objective: To describe real-world care models for teclistamab step-up dosing (SUD) and considerations for successful implementation among community-based practices and/or practices employing outpatient SUD. Methods: This mixed-methods study involved a survey, interviews, and roundtable discussion with US providers with real-world teclistamab experience. Survey topics included their practice’s SUD model, adverse event management, and transition of care processes. Select survey respondents were interviewed to describe their practices’ SUD models in-depth and barriers/facilitators to these models. A subsequent roundtable was held to provide additional context on current models. Results: A total of 38 clinicians from unique practices completed the survey between March-August 2024; 76% worked at community-based practices and 66% had treated ≥5 multiple myeloma patients with teclistamab. Among survey participants, eight completed an interview and seven joined the roundtable. Among the 38 practices, 53% employed outpatient SUD, 26% inpatient SUD, and 21% referred out for SUD. Patient-level requirements for outpatient SUD (n = 20) included caregiver support (90%), proximity to administering site (70%), good performance status (65%), and low disease burden (30%). The top factors which triggered inpatient admissions were any grade immune effector cell-associated neurotoxicity syndrome (85%), grade ≥2 cytokine release syndrome (70%), and abnormal vital signs (60%). Over a quarter of practices (29%) used tocilizumab prophylactically. Conclusion: Outpatient teclistamab SUD has been successfully implemented in real-world practice for appropriately selected patients. This study provides insights into real-world outpatient SUD, including in community practices, to inform providers seeking to implement similar models to improve patient access while reducing cost and resource burden.