Lancman Guido, Song Kevin, White Darrell, Crosbie Tina, Sharif Ismail, Emond Marianne, Saleem Raza Muhammad, Elias Martine, Kaedbey Rayan, Chu Michael P
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
The Leukemia/Bone Marrow Transplant Program of BC, BC Cancer Agency, Vancouver General Hospital, Vancouver, BC, Canada.
Front Oncol. 2024 Nov 26;14:1446995. doi: 10.3389/fonc.2024.1446995. eCollection 2024.
T-cell-redirecting therapies, such as bispecific antibodies and chimeric antigen receptor T-cells, exploit the cytotoxic capabilities of the immune system to destroy cells expressing specific surface antigens, including malignant cells. These therapies have demonstrated unprecedented rates, depth, and duration of responses in relapsed and refractory multiple myeloma. However, there are significant challenges in implementing these therapies into practice, which require multidisciplinary and multicenter coordination and significant healthcare resources to effectively manage these patients. So far, there are no Canadian guidelines for the effective implementation and use of T-cell-redirecting therapies.
This consensus statement was developed based on three advisory meetings held in March, July, and November 2023. During these meetings, a panel of Canadian subject matter experts and representation from Myeloma Canada gathered to discuss the optimal procedures for the use of T-cell-redirecting therapies in the treatment of multiple myeloma. Members of the panel performed a thorough review of randomized clinical trials, real-world data, and other current literature, and provided their up-to-date clinical experience with T-cell-redirecting therapies in Canadian practice settings. Subsequently, asynchronous working groups were appointed to develop unified criteria for patient selection, appraise referral pathways, and devise strategies for management of short-term and long-term adverse events arising from the use of T-cell-redirecting therapies in multiple myeloma.
Here, we present recommendations for optimizing patient selection, referral pathways, and adverse event management in the Canadian practice setting. These recommendations are relevant for hematologists/oncologists, oncology nurses, pharmacists, nurse practitioners, physician assistants, and other providers who treat patients with multiple myeloma, as well as individuals with multiple myeloma and their care partners. These recommendations will be of interest to clinicians who treat patients with MM at community clinics and hospitals and who may be interested in referring patients for T-cell-redirecting therapy.
双特异性抗体和嵌合抗原受体T细胞等重定向T细胞疗法利用免疫系统的细胞毒性能力来破坏表达特定表面抗原的细胞，包括恶性细胞。这些疗法在复发和难治性多发性骨髓瘤中已展现出前所未有的缓解率、缓解深度和缓解持续时间。然而，将这些疗法应用于临床实践面临重大挑战，这需要多学科和多中心的协作以及大量医疗资源来有效管理这些患者。到目前为止，加拿大尚无关于有效实施和使用重定向T细胞疗法的指南。
本共识声明是基于2023年3月、7月和11月举行的三次咨询会议制定的。在这些会议期间，加拿大的一组主题专家以及加拿大骨髓瘤协会的代表齐聚一堂，讨论在多发性骨髓瘤治疗中使用重定向T细胞疗法的最佳程序。小组成员对随机临床试验、真实世界数据和其他当前文献进行了全面审查，并分享了他们在加拿大临床实践环境中使用重定向T细胞疗法的最新临床经验。随后，成立了非同步工作组，以制定统一的患者选择标准，评估转诊途径，并制定策略来管理因在多发性骨髓瘤中使用重定向T细胞疗法而产生的短期和长期不良事件。
在此，我们提出了在加拿大临床实践环境中优化患者选择、转诊途径和不良事件管理的建议。这些建议适用于血液科医生/肿瘤内科医生、肿瘤护士、药剂师、执业护士、医师助理以及其他治疗多发性骨髓瘤患者的医疗服务提供者，以及多发性骨髓瘤患者及其护理伙伴。这些建议将对在社区诊所和医院治疗骨髓瘤患者且可能有兴趣将患者转诊接受重定向T细胞疗法的临床医生有参考价值。
