Preparing the Care Team: Operationalizing Bispecific Delivery and Infectious Risk Management

This segment focuses on the practical, multidisciplinary coordination required to safely administer bispecific antibodies. Donna Catamero, MSN, ANP-BC, OCN, CBCN, outlines the extensive preparation involved, from pharmacy workflows to scheduling logistics to patient education. She stresses the central importance of counseling patients on expected toxicities, particularly CRS, and the emerging role of prophylactic tocilizumab in reducing CRS incidence and facilitating outpatient administration.

Infectious complications emerge as a primary concern. Catamero emphasizes the need for proactive measures: monthly IVIG regardless of serum IgG level, PJP prophylaxis, antiviral therapy, and ensuring patients are fully vaccinated. She notes that while CRS and neurotoxicity are usually predictable and manageable, infections can be insidious and require heightened vigilance and patient–provider communication.

Krishnamachary describes how his community practice incorporates post-transplant vaccination frameworks, long-term antiviral therapy, and strategic use of PJP prophylaxis. The discussion becomes more technical as Jagannath introduces CD4 count monitoring as 1 possible metric, though the panel agrees that practices vary widely and that T-cell-redirecting therapies produce an immunologic landscape resembling post-allo transplant vulnerability. Nooka stresses the importance of layered infectious prophylaxis during the first 2 months, when risk is highest, and the need to balance PJP prevention with the cytopenia risk associated with sulfamethoxazole and trimethoprim.

Collectively, the panel underscores that successful bispecific delivery relies not only on choosing the right drug but on establishing robust systems for monitoring, infection prevention, toxicity recognition, and consistent communication between providers. This segment positions advanced practitioners, pharmacists, and nurses as key players in ensuring treatment safety and continuity across care environments.