Community Care Provider’s Perspective on Administering Bispecifics in Patients with MM


Focused discussion on how patients receiving bispecific therapy for multiple myeloma are transitioned into and managed within the community setting.


Cesar Rodriguez, MD: Kirollos, I have 2 big questions for you about once the patient is transitioned. How is the transition process from your standpoint? Is there a time that’s ideal to receive that patient?

Kirollos S. Hanna, PharmD, BCPS, BCOP: In terms of time of receiving that patient, I don’t find any clinical significance, whether you’re receiving that patient at their second full dose or 2 or 3 cycles in and they’ve already been exposed to 15 doses of teclistamab. That risk is drastically reduced. Clinically, I have some reservations if the patient continues to experience CRS [cytokine release syndrome] during that first dose or second dose. During their first dose, from my perspective on the community side, I’d want to see how tolerant the patient is.

We’ve been collaborating with the care team at the medical center that’s doing the ramp-up, seeing the patient’s status—what that status looks like and what it has been—and making that decision as a team together. We did this with a Mayo patient. It was our first patient, so we wanted to be careful. After everything on our end had been set up, and we got training, my team worked with Scott [Soefje]’s myeloma pharmacist to gain better insight about how this patient has been doing. We already got documentation from the Mayo Clinic about this patient. Things went well. This was a patient done in the outpatient setting, which allowed for a smooth transition. Our finance team was made aware.

We also made the timing of that transition right after an administration of teclistamab. That gives us a week to get things in place. It doesn’t mess things up on another health system in terms of authorization. We made sure to be cognizant of all these things. Because community institutions aren’t going to be ramping up patients, these are very important considerations, much more important than going from your academic infusion center to your community infusion center within the same health system and flipping over the odds. There’s a lot of teamwork that has to go in that.

Cesar Rodriguez, MD: Have you heard of any problems in terms of getting approval to give it in the community?

Kirollos S. Hanna, PharmD, BCPS, BCOP: I haven’t.

Cesar Rodriguez, MD: And to your facility?

Kirollos S. Hanna, PharmD, BCPS, BCOP: I haven’t. I’ve heard rumblings in the community setting. I have claims from March 1st that are still not paid. I haven’t heard anything wrong with them, but we did have similar coding issues as Scott mentioned earlier. We got all that squared away. It’s on my to-do list to make sure we’re getting reimbursement. But as of now, no.

Cesar Rodriguez, MD: That reimbursement can definitely add up if you’re doing it on a weekly basis. It’s all of March, April, and now May. We need to pressure the drug companies and insurance to make sure reimbursement is done in an expedited way; otherwise, it’s going to be prohibitive for community practices to give. I’m glad to hear you’re transitioning nicely from the Mayo Clinic. At Mount Sinai we’re also doing the transition pretty smoothly. Have you had any patients develop CRS or complications while you’re treating them in your practice?

Kirollos S. Hanna, PharmD, BCPS, BCOP: To date, since we’ve implemented this process—we’ve implemented this process for only 2.5 or 3 months—we’ve treated 7 patients. All of them have been doing just fine. Those patients didn’t require a long hold, which is another logistical or operational consideration to keep in mind. If you hold the patient more than 28 days, you have to restart from the beginning, and then you get them back in the hospital or health system you started with. But we haven’t seen anything on our end in terms of that.

Transcript edited for clarity.

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