ICML 2025 | How smaller centers should prepare for managing CRS, ICANS, & infections associated with bispecifics

You want to talk to other centers who have done this, who have safely managed patients with CRS or neurotoxicity. You want to really figure out the best management plan to make sure that you know exactly what to do if a patient does have CRS. You know, what drugs to use? Do you bring them into the clinic? Do you bring them into the hospital? What does that look like? Maybe some little tidbits of, oh, so-and-so’s temperature might be 99. They don’t have a true fever yet. What would you do in this situation? I always say it’s good to kind of do a mock patient run. I’ve done this with other groups, like it’s two o’clock in the morning and Joe calls and here’s what’s going on. What do you do? And so you want to have a really good, precise management plan. You can find a lot of that guidance in the Blood paper that Dr Crombie and I published in January of 2024. It has a lot of good tools in there for the tables and information on how to do this but again you want to sort of do a little bit of a run through and know what that looks like and again don’t be afraid to phone a friend. Don’t be afraid to ask another doctor such as myself or other community docs that are doing this you know What did you do? How did it work for you? 

We also have a checklist that we go through with each patient that starts a bispecific. We make sure that they and their caregiver know what to look for. We make sure they have all their monitoring equipment. We make sure they know how to use their monitoring equipment. So it’s sometimes just the little things that really help. And really just having a really precise management plan is key.

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