A review of single-center studies showed that prophylactic use of tocilizumab in patients receiving step-up dosing of bispecific antibodies could reduce the severity of cytokine release syndrome (CRS) and may support outpatient dosing in those with relapse or refractory multiple myeloma (MM).
Valerin Amo, MD, MS, of St. Joseph’s University Medical Center in Paterson, New Jersey, and colleagues presented the findings at the 2026 SOHO Annual Meeting.
They assessed three original studies representing standard-dose prophylaxis, low-dose prophylaxis, and outpatient implementation. Patients received BCMA- or GPRC5D-directed bispecific antibodies, and the study assessed the following factors: bispecific agent, tocilizumab dose and timing, inpatient versus outpatient setting, comparator use, CRS, immune effector cell-associated neurotoxicity syndrome (ICANS), hospitalization, additional CRS-directed therapy, and response when reported.
In the first study, a large real-world cohort, 119 patients received tocilizumab 8 mg/kg before the first bispecific step-up dose. Any-grade CRS occurred in 10.1% of patients, specifically:
- 0% receiving talquetamab
- 5% receiving elranatamab
- 9% receiving teclistamab
- 0% receiving linvoseltamab
Ten CRS events were grade 1, two were grade 2, and none were grade ≥3. ICANS occurred in 5.9% of patients, with 2.5% being grade ≥3. No additional tocilizumab or corticosteroids were required for CRS management. The overall response rate was 65.7%.
In the second study, prophylactic tocilizumab 4 mg/kg was associated with lower rates of CRS than historical controls who did not receive prophylaxis (21% vs 55%), with grade 2 CRS occurring in 2% of patients receiving tocilizumab versus 21% in the historical control cohort.
In the third study assessing outpatient step-up dosing in 52 selected patients receiving prophylactic tocilizumab, CRS occurred in 19.2% and ICANS in 5.8%; hospitalization was required for toxicity management in 7.7% of patients.
The researchers noted that the studies assessed are limited by nonrandomized design, institutional selection criteria, variable dosing strategies, and limited prospective data on ICANS, infections, efficacy, and healthcare utilization. Multicenter prospective studies are needed to further assess the use of prophylactic tocilizumab.
Reference
Amo V, Sorathia AZ, Almonacid Y, Isshak R. Prophylactic tocilizumab during bispecific antibody step-up dosing in relapsed/refractory multiple myeloma: CRS mitigation, low-dose strategies, and outpatient feasibility. Abstract MM-1659. Presented at the 2026 Society of Hematologic Oncology Annual Meeting; September 9-12, 2026; Houston.
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