Test your knowledge of Relapsed Multiple Myeloma Treated with Teclistamab

Which of the following statements best describes the mechanism of action of teclistamab and appropriate patient selection?
Teclistamab is an anti-BCMA antibody-drug conjugate best suited for patients with early relapse multiple myeloma after first-line therapy
Teclistamab is a BCMA x CD3 bispecific antibody that redirects T cells to BCMA-expressing myeloma cells and is indicated for triple-class– exposed relapsed/refractory multiple myeloma
Teclistamab is a GPRC5D x CD3 bispecific antibody most appropriate for patients who have failed BCMA-directed CAR-T cell therapy
Teclistamab is a monoclonal antibody targeting CD38 on myeloma cells, indicated for patients who have failed lenalidomide maintenance therapy
In the above case, the patient JD developed CRS, which included a fever (38.9°C) and hypotension (85/50 mmHg), about 18 hours after receiving the first full dose of teclistamab. What is the most appropriate initial management?
Permanently discontinue teclistamab and administer high-dose corticosteroids
Continue teclistamab at a reduced dose and manage symptoms with acetaminophen only
Administer tocilizumab, supportive care (IV fluids, oxygen), and consider corticosteroids, as well as temporarily holding teclistamab until resolution
Switch the patient to an alternative bispecific antibody with lower risk of cytokine release syndrome
Which of the following represents the most comprehensive approach to infection prevention before and during teclistamab therapy?
Screen for active infections at baseline; administer acyclovir for herpes zoster prophylaxis; monitor complete blood counts weekly for the first month
Ensure the patient is up to date on all vaccinations including COVID-19; screen for hepatitis B, C, and HIV; provide prophylaxis for Pneumocystis jirovecii pneumonia and herpes viruses; monitor immunoglobulin levels regularly and administer IgG replacement if levels fall below 400 mg/dL
Administer IVIG before the first dose of teclistamab regardless of baseline immunoglobulin levels; provide prophylactic antibiotics only if neutropenia develops; delay treatment until absolute neutrophil count exceeds 1,500/μL
Provide prophylaxis only for patients with prior history of opportunistic infections; monitor immunoglobulin levels monthly; consider G-CSF only for grade 4 neutropenia with fever
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