Abstract
Multiple myeloma (MM) is a plasma cell malignancy that impairs immune regulation, leading to increased infection risk and disease-related complications. While advances in therapy have improved survival, MM remains incurable, with most patients eventually relapsing. T-cell–based immunotherapies, such as chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies (bsAbs), have emerged as powerful treatment options for relapsed/refractory MM (RRMM). CAR T-cell therapy involves complex manufacturing and requires administration in specialized centers due to the risk of severe toxicities such as cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). These therapies demand trained personnel, hemodynamic monitoring, and access to intensive care. Bispecific antibodies, in contrast, are off-the-shelf agents that redirect T cells to malignant plasma cells and offer more flexible, outpatient-friendly administration. While bsAbs can also cause CRS and neurotoxicity, these events are typically milder and more manageable. Despite their promise, bsAb therapies still require infrastructure for toxicity management, monitoring of prolonged cytopenias, and infection prevention. Prophylactic strategies, such as early tocilizumab use, may facilitate safer outpatient delivery. Expanding access to bsAbs, especially in community settings, requires 24/7 clinical support, caregiver engagement, and training for local providers. Advanced practice providers, with their advanced clinical skills and holistic patient care approach, are well-positioned to lead in patient education, early identification, and care coordination. Their involvement is essential to promoting equitable access to novel therapies and improving outcomes. Broader implementation of bsAbs will require investment in infrastructure, education, and interprofessional collaboration to ensure safe, equitable, and effective MM treatment.
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