Academic–Community Coordination: Ensuring Safe Transitions of Care

This segment addresses one of the most rapidly evolving challenges in myeloma therapeutics: how to safely transition bispecific-treated patients between academic and community settings. Catamero highlights the logistical complexities of bispecific initiation, especially when step-up dosing is performed in an academic center and maintenance therapy continues locally. Insurance reauthorization emerges as a critical and often underestimated source of treatment delay, prompting the need for advance planning before discharge.

Both she and Krishnamachary stress the importance of direct communication beyond electronic medical records. Community clinicians must know exactly when doses were administered, how step-up dosing was tolerated, and what complications arose. Krishnamachary describes his own practice’s workflow, which includes proactive engagement between clinical teams, pharmacy directors, and scheduling staff to ensure seamless continuation of therapy.

Safety during the early treatment window is a core theme. The panel emphasizes that CRS and ICANS are primarily early events managed by the initiating center, while infections become the dominant risk once the patient returns to the community. Thus, clarity on who the patient should call, what constitutes an emergency, and how quickly the community team can evaluate fever is essential.

Nooka explains that once step-up dosing is complete, every fever should be treated as infection until proven otherwise, reinforcing the shift from cytokine-mediated side effects to opportunistic infection concerns. He emphasizes predictable toxicity timelines and the importance of educating patients deeply on what to expect.

The segment concludes by positioning this academic–community partnership as the linchpin enabling widespread, equitable access to bispecific therapy. Without clear communication, shared protocols, and shared responsibility, the promise of bispecific antibodies cannot be fully realized in real-world practice.