Teclistamab

How it works

It bridges BCMA on myeloma cells to CD3 on T-cells, redirecting T-cell-mediated cytotoxicity to kill malignant plasma cells.

Prescribing in practice

• Carries a significant risk of cytokine release syndrome and neurological toxicity including ICANS, so step-up dosing, premedication, and administration with monitoring and resuscitation facilities available are mandatory.
• Causes serious infections and marked, sometimes prolonged neutropenia and hypogammaglobulinaemia; infection prophylaxis and immunoglobulin support may be needed.
• Initiation and step-up dosing should occur where patients can be observed for the recommended period, and patients should avoid driving during the relevant window because of neurological risk.

Monitoring

Monitor for cytokine release syndrome and neurological symptoms during step-up dosing, and check full blood count and for signs of infection regularly.

Counselling the patient

• Seek urgent help for fever, confusion, severe headache, or difficulty speaking.
• Report any signs of infection promptly, as the immune system may be weakened.
• Do not drive or operate machinery during the period advised after each step-up dose.

Evidence & guidelines

Teclistamab's efficacy in heavily pretreated myeloma was demonstrated in the MajesTEC-1 study, supporting its licensed indication.