Low Dose Tocilizumab for Mitigation of Cytokine Release Syndrome With T-Cell Engaging Bispecific Antibodies
Year: 2026
Type: article
Abstract: BACKGROUND: Cytokine release syndrome (CRS) is one of the most common adverse effects of T-cell engaging bispecific antibodies (T-BsAbs) during the step-up dosing (SUD) phase of treatment. Previous studies demonstrated that a single prophylactic tocilizumab (Toci) dose of 8 mg/kg mitigated the incidence CRS events. Herein, we evaluated the efficacy of a low Toci dose (Toci-lo) of 4 mg/kg for CRS prophylaxis during the SUD phase. METHODS: The study included relapsed/refractory multiple myeloma patients, treated with T-BsAbs and received prophylactic Toci-lo (cohort 1) administered prior to the first SUD only. A historical patient cohort that did not receive Toci prophylaxis was identified (cohort 2) for comparison. The CRS rates were compared between the 2 cohorts using the Fisher's exact/Chi-square test. Univariate/multivariate logistic regression analysis was performed to estimate the odds of CRS events with Toci-lo prophylaxis. RESULTS: A total of ninety patients were included in the final analysis (56 in cohort 1 and 34 in cohort 2). CRS rate was significantly lower in cohort 1 (21%, 95% CI:10.7%-37.8%) compared to cohort 2 (55%, 95% CI: 38.0%-70.8%; P = .009). Grade 2 CRS rates were 2% and 21% in cohorts 1 and 2, respectively (P = .0041). Based on multivariate logistic regression, Toci-low was associated with a significant reduction in CRS rates (OR: 0.2, 95% CI: 0.06-0.65; adjusted P = .01). CONCLUSION: Based on our findings, prophylactic Toci-lo proved to be effective in reducing CRS events during the SUD phase of treatment with T-BsAbs. The implementation of this prophylactic strategy in clinical practice might minimize healthcare expenditures.
Authors: Issam S. Hamadeh, Maximillian Merz, Andriy Derkach, Lisa Modelevsky, Alexander M. Lesokhin, Sham Mailankody, Malin L. Hultcrantz, Carlyn R. Tan, Hani Hassoun, Urvi A. Shah, Kylee Maclachlan, Sridevi Rajeeve, Hamza Hashmi, Francesco Maura, Ross S. Firestone, Alice X. Wang, Anjali Amin, Dhwani Patel, Michael Scordo, Gunjan L. Shah, Heather J. Landau, Sergio Giralt, Saad Z. Usmani, Neha Korde
Institution: Memorial Sloan Kettering Cancer Center
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,890
OpenAlex ID: W7141737780